Care Coordination Nurse I

Blue Cross and Blue Shield of Louisiana

. Assess members’ status by collecting in-depth patient information and identifying needs .

Posted 10/2/2026full-timeRemote • Louisiana • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care coordination, disease management, and utilization management, with a strong focus on effective communication and compliance with regulatory guidelines. Proficient in medical terminology, coding guidelines, and benefit administration to ensure quality patient care and operational efficiency.

Highest-signal resume keywords

LPN LicenseManaged Care ExperienceICD-10 KnowledgeCPUR CertificationCare Coordination

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Patient AssessmentDisease Management PlanningUtilization ManagementMedical Necessity ReviewsContract Benefit InterpretationICD CodingHCPCS CodingCPT CodingData AnalysisCost-Effective Decision Making

Soft Skills

Effective CommunicationDetail-OrientedOrganizational SkillsProfessional JudgmentSelf-Motivated

Tools & Technologies

Office EquipmentRelated Software

Certifications & Qualifications

LPN LicenseCPUR CertificationCPC CertificationCMCN Certification

Industry Keywords

Managed CareClaims ProcessingInsurance OperationsReinsuranceMedicare Guidelines

About the role

Key responsibilities & impact

Assess members’ status by collecting in-depth patient information and identifying needs
Develop and implement comprehensive disease management plans with specific objectives, goals, and actions
Implement interventions to accomplish established goals
Coordinate, organize, integrate, and modify resources needed to accomplish goals
Monitor plans by gathering information and evaluating effectiveness
Meet staff and unit performance targets and department productivity goals
Perform care coordination or Utilization Management as designated by RN and/or clinical leadership
Research and interpret contract benefits to facilitate accurate benefit administration and product-specific authorization requirements
Conduct medical necessity reviews using accepted criteria, guidelines, medical delegations, and policies
Review, resolve, and respond to utilization-of-benefits issues and coordinate appropriate care
Negotiate payment rates when provider network deficiencies exist
Calculate and document care management savings, identify product enhancement opportunities, and capture ROI
Communicate with members and providers regarding contract requirements and collect planned-care information by telephone
Manage verbal notifications and written materials in compliance with regulatory and operational guidelines
Serve as a technical resource to non-clinical staff by interpreting clinical information
Perform other job-related duties within scope of responsibilities

Requirements

What you’ll need

High School Diploma or equivalent required
4 years of direct patient care experience required
Managed Care or claims processing experience
Knowledge of medical terminology and ICD-10 codes
Current, unrestricted LPN license in Louisiana and/or required jurisdictions where services are provided
CPUR, CPC, or CMCN certification preferred upon hire and required within 24 months in position
Knowledge of insurance, reinsurance, and/or customer service operations preferred
Ability to research and analyze cases and make quality and cost-effective decisions
Effective communication with members, providers, pharmacy staff, and employees at all organizational levels
Detail-oriented, organized, and self-motivated
Professional judgment and ability to make decisions and delegate work appropriately while managing multiple tasks
Working knowledge of related software and office equipment
Ability to comprehend Medicare guidelines and assume responsibility for guideline-based decisions
Knowledge of ICD, HCPCS, and CPT coding guidelines preferred
Ability to work in the United States without employer-sponsored immigration support
Residency in or relocation to Louisiana preferred

Benefits

Comp & perks

Employee resources to live well, be healthy, continue learning, develop skills, grow professionally, and serve local communities
Reasonable accommodations for individuals with disabilities
Smoke- and tobacco-free work environment
Pre-employment drug screening and background screening