Clinical Navigator, RN - Care Management at Blue Cross Blue Shield of Michigan in Detroit, Michigan

Job Description:

Accept referrals from Member Advocates and Customer Service Representatives to address members' short-term clinical needs and episode-based health issues. Use clinical judgement to help members understand their health and navigate to the right health care resources, while leveraging technology and team members.  Clinical Navigators will communicate with members through phone, email, digital app and text.

• Use active listening, motivational interviewing, critical thinking, and clinical judgment to assess member's short-term needs and provide real-time clinical support, coaching and guidance for members and their family.  


• Help members understand their health conditions and connect them with the appropriate resources, benefits and programs. 


• Leverage BCBSM technology and data to personalize member engagement and provide data-driven recommendations.


• Telephonic clinical triage activities


• Collaborate with team members including Member Advocates and Care Managers on individual cases to share insights and resolved member issues. 


• Use proactive problem solving to resolve health care issues and barriers members face.


• Perform other related duties as required.

"Departmental Qualifications"

• Previous experience working in a call center, telephone triage, telephonic case management, or experience in ER or ICU is strongly preferred.

• Nursing Diploma or Associates degree in Nursing is required. 


• Bachelor's degree in Nursing is preferred. 


• 2 or more years of clinical nursing experience in a clinical, acute care, or community setting is required.


• Current, active and unrestricted Michigan Registered Nurse License is required.


• Previous experience working in a call center, telephone triage, telephonic case management, or experience in ER or ICU is strongly preferred.


• Ability to provide flexible coverage from 8am-8pm to support member outreach during/outside of normal business hours.


• Excellent interpersonal and communication skills both written and verbal.


• Demonstrated time management skills.


• Basic computer and typing skills.


• Good interpersonal skills required to work effectively on teams.


• Ability to multi-task, while still being thorough when dealing with members.


• Empathetic, supportive and a good listener.


• Strong decision making and problem-solving skills.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.