RN Specialist Complex Case Manager - Oncology Specialist

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 built on values of succeeding together, finding a better way, and doing the right thing.

About the Role

The RN Specialist will utilize key principles of case management to research and analyze members’ health needs and healthcare cost drivers. Working closely with an interdisciplinary care team, you will ensure members have an effective plan of care that leads to optimal, cost-effective outcomes. This role leverages clinical expertise, strong critical thinking, and a keen business sense to collaborate with members and their families, avoiding unnecessary hospitalizations and emergency department utilization while optimizing site of care and ensuring evidence-based treatment.

This position is an Oncology Specialist RN Case Manager role, focusing on supporting members living with cancer and undergoing treatment.

Responsibilities

• Receive referrals for members with high-cost, complex medical conditions and conduct telephonic outreach to engage members, families, and providers in the complex case management program.
• Conduct clinical assessments using motivational interviewing; gather, analyze, synthesize, and prioritize member needs based on assessments and research. Collaborate with the interdisciplinary care team to develop a comprehensive plan of care.
• Collaborate and communicate with the healthcare team (member, family, providers) to create a plan of care that produces positive clinical results and promotes high-quality, cost-effective outcomes.
• Identify relevant BCBSMN and community resources and facilitate program and network referrals.
• Monitor, evaluate, and update the plan of care over time.
• Ensure member data is documented according to BCBSMN application protocols and regulatory standards.
• Maintain an outstanding level of service at all points of customer contact.
• Understand the strategic and financial goals of the department, complex care management teams, and the enterprise.
• Demonstrate knowledge of health plan operations (e.g., networks, eligibility, benefits).
• Promote innovative solutions to improve day-to-day functions and enhance department operations.
• Collaborate with the interdisciplinary care team to develop strategic interventions addressing member needs and healthcare cost drivers.
• Engage providers telephonically to review and align treatment plans with benefits, medical reimbursement policies, and care coordination.
• Identify and implement cost-saving opportunities to ensure optimal and cost-effective health outcomes.

Requirements

• Registered Nurse with a current, unrestricted MN license.
• 5 years of relevant clinical care experience (all relevant experience, including work, education, transferable skills, and military experience, will be considered).
• CCM Certificate or ability to obtain within 3 years of starting the position.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Qualifications

Required Skills:

• Excellent telephonic skills.
• Keen business acumen.
• Excellent communication, conceptual thinking, and relationship management skills.
• Strong organizational and resiliency skills.
• Proficiency in computer applications.
• Strong research, analytical, and creative problem-solving skills.
• Flexibility to work varied hours.

Preferred Skills:

• 2+ years of managed care experience (e.g., case management, health coaching, utilization management, or auditing; may be included in the 5 years of clinical experience).
• 3+ years of recent Oncology experience in a hospital, clinic, or as an Oncology Telephonic Case Manager for an insurance company.
• Recent Chemotherapy administration experience.

Schedule

This is a Remote Teleworker role (full-time remote).

Pay

Annual pay range: $79,100.00 – $104,800.00 – $130,500.00. Pay is based on several factors, including skills, ability, and knowledge.

Benefits

• Medical, dental, and vision insurance.
• Life insurance.
• 401k retirement plan.
• Paid Time Off (PTO).
• Volunteer Paid Time Off (VPTO).
• Additional benefits available (review our benefits page for more details).