Summary

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. 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 Guide Well 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.

What Will You 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
  • Performs other duties as assigned.

What Must You Have?

• 1+ years related work experience.
• Experience Details: Nursing
• High school diploma or GED
• RN - Registered Nurse - State Licensure And/or Compact State Licensure Active Florida
• RN license Upon Hire
• BCLS - Basic Life Support CPR Certification Upon Hire
• Health Coaching Certification 180 Days
• Knowledge and understanding of benefit plans
• Knowledge of healthcare continuum
• Experience with automated medical systems
• Health Coaching Certification within 6 months after hire that will remain current during employment
• 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
• • 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 resources

General Physical Demands:

Sedentary work: 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 communities.