Onsite RN Navigation Nurse - Florida Blue Center (Boynton Beach, FL)

Love engaging with people to help them achieve better health? Come join the exciting, rapidly expanding Direct-to-Consumer team. We make it our priority to utilize our skills and knowledge to help members make positive changes in their health and well-being. While on this team you will proactively 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.

Important to Know

• Must reside in Boynton Beach, FL or surrounding area to the Florida Blue Center located at 1501 N. Congress Ave, Boynton Beach, FL 33426

• The work schedule is 40 hours per week during the hours of 9am -6pm Monday - Friday with occasional Saturday work during peak times and scheduled events

• Must have an active Florida State RN License and/or Compact States Licensure that covers the State of Florida 

• Active Basic Life Support CPR Certification (BCLS)

What You'll Be Doing

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 in order to provide the most effective and efficient customer service.

• Collaborating with various 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; e.g. assists with access to care issues.

• Providing referrals to community resources such as elder care.

• Educating prospective customers and members on benefits structure and care setting alternatives.

• Educating prospective customers and members and helping them access and understand 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
   

What We Require

• 1+ years related work experience in Nursing 

• High school diploma or GED 

• Active RN - Registered Nurse Florida State Licensure and/or Compact States RN Licensure that include Florida Upon Hire

• BCLS - Basic Life Support CPR Certification Upon Hire 

• Health Coaching Certification 180 Days 

• Benefit plan knowledge and healthcare continuum

• Experience with automated medical systems 

• Ability to obtain Health Coaching Certification within 6 months after hire that will remain current during employment

What We Prefer

• 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 benefit plans Knowledge of provider contracting and reimbursement methodologies 

• Knowledge of member tools such as the Member Portal. care management, disease management and similar care programs 

• Knowledge of community resources, health and specialty products and ability to inform others of how to use benefits in conjunction with specific illnesses

• Bilingual Spanish and/or Creole
   

General Physical Demands

• Exerting up to 10 pounds of force occasionally to move objects. 

• Jobs are sedentary if traversing activities are required only occasionally. 

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

• Occasionally may be exposed to outdoor weather conditions of cold, heat, wet, and humidity. 

• Occasionally may be exposed to outdoor or warehouse conditions of loud noises, vibration, fumes, dust,