Job Description

What is your impact:

This key position is responsible for assisting members within a geographical (local, statewide and/or other) area make effective health care choices for self-management of their acute and /or chronic condition(s). Utilizing a member-centric approach they assist members, and their families understand and manage their disease process by: reinforcing the physicians’ plan of treatment, promoting healthy behaviors and lifestyle changes, and providing education and tools to promote self- management to improve health outcomes and reduce overall costs. Individual care plans are developed in collaboration with the Physician, Member/Care Giver, Families, and the Care Team. Ongoing coaching, monitoring and evaluation of care plans will be done face to face with the member, telephonically, digital engagement or electronically through email and member and provider portals.

What Are You Key Responsibilities

• Engage Members telephonically, using digital engagement tools and/or face to face at Florida Blue Retail Centers, hospitals, etc. with a focus on health coaching and member education. Facilitate access to care and resources to meet the member’s health care needs. Provide education and tools to promote self-management.
• Plan, implement, coordinate and monitor Case Management activities that may include acute and non-acute services, outpatient services, behavioral health and / or community resources.
• Facilitate care for high risk members across the continuum of the health care experience, including care transitions, coordination of community and social service and coordinating with other value-based organizations, providers as needed
• Close gaps in care
• Conduct Medication Reconciliation
• Collaborate with Member, Member’s Physicians, Plan Medical Directors, Managers, Local, Regional and Specialty team members as well as other functional areas to assist the member to meet their health care goals
• Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses
• Assist Members and their physicians to navigate through the health continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access

What Is Required

2+ years related work experience. Experience Details: Communicating and building relationships with members/providers/employers both telephonically as well as live

Related Bachelor’s degree or additional related equivalent work experience

Required Licenses and Certifications

RN – Registered Nurse – State Licensure And/Or Compact State Licensure

Experience with influencing and motivating individuals to change health behaviors

Knowledge and/or experience with population health

Experience in two or more of the following: home health care, utilization review, discharge planning, disease/ case management

Experience Working With Managed Care Products, Benefits And Services

Experience in planning, implementing coordinating and monitoring activities that focus on acute and non-acute services, outpatient services and/or community resources for all lines of business

Non-traditional working hours to meet the member’s availability

Basic to intermediate experience in MS Word, Excel, tablet and/or smartphone .Basic technology skills with digital tools and apps.

Travel up to 30% (subject to change) for on-site member/provider/employer meetings, events or manager requests with occasional overnight stays

What Is Preferred

CCM – Certified Case Manager

Bilingual English/Spanish and/or Creole

Direct clinical experience

Experience working remotely

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities

Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

What We Offer

As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, Short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan includes employer contribution and employer match;
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range: $68,100 – $110,600

Typical Annualized Hiring Range: $68,100 – $85,100

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.

About Us

At GuideWell, we are committed to making diversity, equity and inclusion part of everything we do. We believe in hiring people who represent the communities we serve while creating a workplace that encourages a sense of belonging for everyone, no matter who you are or where you come from.

From students to former military to seasoned professionals, our family of mission-based companies are stronger because of the unique talents and skills of our employees. We believe everyone’s contribution has the power to help people and communities achieve better health. Find your new team today.

Organization

Florida Blue, A GuideWell Company, has been providing health insurance to residents of Florida for 75 years. Driven by its mission of helping people and communicating to achieve better health, the company serves more than five million health care members across the state. We are looking for exceptional people who will bring our mission to life and succeed by putting the members first.