Clinical Guide
Clinical Guide
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Job Description
About Blue Cross and Blue Shield of Minnesota
At Blue Cross and Blue Shield of Minnesota we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate you are joining a culture that is built on values of succeeding together finding a better way and doing the right thing. If you are ready to make a difference join us.
The Impact You Will Have
The Clinical Guide is a critical component of BCBSMs Integrated Health Management team. The position exists to provide member provider and delegate resourcing; e.g. problem solving benefit management education and program referrals. Additionally the Clinical Guide serves as a subject matter expert to team members and BCBSMN.
Your Responsibilities
- Responds to member provider customer service company and external partner referrals and/or questions. Provides referrals education and support coordination to appropriate community resources.
- Evaluates members needs to assess the members needs identify and vet resources to support the member holistically. Facilitates referrals to Case Management Programs as appropriate.
- Gathers accurate and comprehensive information required for benefit and/or member management.
- Serves as a resource to members and their families e.g. navigating services in the health care system as well as to other business units for unique and/or complex cases.
- Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department.
- Ensures member data is documented according to BCBSMN application protocol and regulatory standards.
- Maintains outstanding level of service at all points of customer contact.
- Understands broadbased goals of assigned market segment(s) including clinical and service availability.
Required Skills and Experience
- RN with MN license or LSW with no restrictions
- 3 years relevant clinical experience
- 1 years of medical call center or managed care experience; e.g. case management utilization management
- All relevant experience including work education transferable skills and military experience will be considered
- Outstanding communication skills
- Outstanding analytical thinking skills
- Outstanding task facilitation skill
- Strong computer application skills
- Medicare and/or Public Programs experience
- High school diploma (or equivalency) and legal authorization to work in the U.S.
Role Designation
Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.
Compensation and Benefits
$67200.00 - $89100.00 - $111000.00 AnnualPay is based on several factors which vary based on position including skills ability and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
Medical dental and vision insurance
Life insurance
401k
Paid Time Off (PTO)
Volunteer Paid Time Off (VPTO)
And more
To discover more about what we have to offer please review our benefits page.
Equal Employment Opportunity Statement
At Blue Cross and Blue Shield of Minnesota we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply please contact us at:
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Employment Type
Full-Time
