RN - Navigation Nurse Florida Blue Retail Center (Sarasota, FL)

Company: GuideWell
Location: Sarasota
Posted on: May 12, 2022

Job Description:

What Will Be Your PurposeProactively manage prospective customers and members' experience through the health care continuum and delivery system in a Florida Blue Center environment by assessing needs, educating on benefit plans, costs, choices, tools, and programs, and referring to Florida Blue programs and resources as appropriate. Contacts and referrals can come from a variety of internal and external sources, including member self-service, Care Managers, the member contact center, third party vendors such as Health Dialog, wellness/health fairs and GuideWell Enterprise Channels. Present health education classes and programs to members and non-members. Perform Personal Health Assessments on members and provide education on ways to achieve better health.Important to Know

• Must reside in Sarasota, FL or surrounding area
• Requires the following Licenses & Certifications
  • RN State Licensure Upon Hire
  • Health and Life Insurance License
  • BCLS - Basic Life Support CPR Certification Upon Hire
  • Health Coaching Certification within 180 Days of Hire
  • Must be able to work events in/outside of the center, 1 Saturday a month and 1-2 evenings per week (10:30am-7:30pm).
  • Bilingual is a plusWhat Will Be Your Purpose?Provides personal, Care engagement and assistance with coordination of health care benefits and services to prospective customers and members in the Direct-to-Consumer Channel by:
    • Performing Personal Health Assessments and providing education on the biometric results
    • Closing member care gaps by accurately documenting test results in the clinical record
    • Presenting health education classes and programs
    • Performing prospective customer and member needs assessment to provide the most effective and efficient customer service.
    • Collaborating with various internal teams to improve the Enterprise STARS rating through targeted member campaigns.
    • Participating in outbound call campaigns to members for Enterprise Partners, including Commercial, U65, and Medicare teams.
    • Facilitating benefit savings for members by proactively educating them on benefit plan impacts and choices.
    • Facilitating problem solving and issue resolution with access to care issues.
    • Providing referrals to community resources such as elder care.
    • Educating prospective customers and members on benefits structure, care setting alternatives, accessing, and understanding cost and quality comparisons.
    • Providing appropriate referrals to other corporate programs such as, Healthy Addition, New Directions and Care Management.
    • Coordinating care for members as appropriate using a personalized care plan.
    • Host Customer Video Appointments.
    • Educate members on digital platforms such as Blue for Me and MeQuilibrium
    • Performs other duties as assigned.What You Must Have
      • 1+ years related work experience Nursing, Health Educator
      • High school diploma or GED
      • Required Licenses and Certifications
        • Registered Nurse (RN) State Licensure and/or Compact State Licensure Active Florida RN license Upon Hire
        • Basic Life Support CPR Certification (BCLS) Upon Hire
        • Health Coaching Certification Upon 180 Days of being Hired
          • Knowledge and understanding of benefit plans and healthcare continuum
          • Experience with automated medical systems
          • 3 or more years' managed care, case management, disease managements, clinical nursing, home health care or related experience with hands-on patient interaction
          • Sales work experience
          • Knowledge of provider contracting and reimbursement methodologies
          • Knowledge of member tools such as the Member Portal
          • Knowledge of care management, disease management and similar care programs
          • Knowledge of health and specialty products and ability to inform others of how to use benefits in conjunction with specific illnesses
          • Knowledge of community resourcesWhat We Prefer
            • Associate Degree in Nursing (ADN)
            • Experience as a point of contact for referring physicians, patients, and caregivers to provide resources and assistance with accessing clinical and supportive care services.
            • Proven experience maintaining and continually building rapport and trust with our community partners, agencies, and members.
            • Excellent presentation skills to deliver training, and host speaking engagements when promoting our plansGeneral Physical Demands
              • Exerting up to 10 pounds of force occasionally to move objects.
              • Jobs are sedentary if traversing activities are required only occasionally.We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communitie

Keywords: GuideWell, Sarasota , RN - Navigation Nurse Florida Blue Retail Center (Sarasota, FL), Hospitality & Tourism , Sarasota, Florida