Job Description

USE YOUR STRENGTHS AS A BEHAVIORAL HEALTH NAVIGATOR (RN) AT WELLMARK!

ABOUT THE OPPORTUNITY: You will provide behavioral health support service to Wellmark members while utilizing your healthcare system and community resource knowledge and expertise to provide consultation and responses to support requests. You will proactively assesses and assists members with care needs to help connect them with community and employer services and resources efficiently. As part of a multidisciplinary care team, you will continuously look for ways to improve processes and maximize health dollars for our members. TOP CANDIDATES WILL HAVE EXPERIENCE WORKING WITHIN A HEALTH PLAN.

Qualifications

REQUIRED:

• Completion of an accredited nursing program.
• Nursing degree with behavioral health experience
• Active and unrestricted RN License in Iowa, Compact State or South Dakota. Individual must be licensed in the state in which they reside.
• Certified Case Manager (CCM); must obtain within 24 months of hire.
• 4+ years of diverse clinical experience including behavioral health (e.g., acute care, outpatient, home health, etc.) that reflects 4+ years of direct clinical care to the consumer. Experience in utilization management or health insurance setting beneficial.
• Commitment to service excellence and member advocacy. Anticipates member and provider needs and takes appropriate actions; thinks critically and creatively yet understands resources and guidelines.
• Operates with agility, flexibility, and resourcefulness; effectively manages and adapts to change.
• Ability to organize multiple priorities and succeed in a dynamic work environment where quality goals are measured. Committed to timeliness, follow up, accuracy and detail.
• Strong verbal communication skills. Influences action and facilitates crucial conversations on care with members, physicians, and care facilities. Excellent crisis-counseling and problem-solving skills.
• Strong written communication skills, including accurate documentation of events within electronic documentation system; ensures quality and consistency by following set guidelines and processes.
• Develops collaborative relationships and maintains professionalism with peers, stakeholders, and members.
• Strong technical acumen; learns new technology and systems quickly – e.g., Microsoft Office Suite, electronic charting, documentation systems.

PREFERRED:

• Psychiatric-Mental Health Nursing Certification (PMH-BC)
• Experience in health insurance setting beneficial.
• Previous experience working independently and managing an assigned caseload in a metrics-based environment.
• Knowledge of regulatory standards and regulations – e.g., URAC, NCQA, HIPAA, PHI, confidentiality.

Additional Information

a. Provide behavioral health expertise and collaborate with members and employer groups to evaluate needs and identify community and employer resources. Partner with and make referrals to Case Management for ongoing long-term needs. b. Work with health care provider and community resource staff in a courteous and professional manner in gathering medical resources and services. c.Document activity and decisions accurately, consistently, and timely within the care management documentation system by following the standard work guidelines and policies to support internal and external processes, including documentation of community and employer resources provided. Meet both quality assurance and production metrics as established for the role. d. Comply with regulatory standards, accreditation standards and internal guidelines. e. Document activity and decisions accurately, consistently, and timely within the care management documentation system by following the standard work guidelines and policies to support internal and external processes. Meet both quality assurance and production metrics as established for the care team. f. Other duties as assigned.

REMOTE ELIGIBLE: You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other ‘moments that matter’ as well.  

AN EQUAL OPPORTUNITY EMPLOYER

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com