Beyond the Bedside: Nursing at Independence Blue Cross

Independence Blue Cross (Independence) is proud to honor exceptional nurses in the region through our fourth annual Celebrate Caring campaign. If you know a nurse who has gone above and beyond when it mattered the most, submit your story by March 11 for a chance to have that nurse recognized in a special way through Celebrate Caring. As part of this special campaign, we’re also highlighting the important work of our own nurses and how they keep our communities healthy through non-traditional nursing roles at Independence.

Nurses are crucial to the health and well-being of our communities. Independence recognizes and thanks nurses for everything they do.

We are especially proud of the contributions of our own dedicated nurses. More than 270 nurses work at Independence to help advance our mission to enhance the health and well-being of the people and communities we serve.

Through a variety of roles, Independence nurses support and empower our members to take control of their health and help ensure the efficient delivery of high-quality health care.

Taking Member Health to the Next Level

Members may be most familiar with the services that Independence nurses provide as Health Coaches. Our Registered Nurse Health Coaches and case managers help members navigate their health care benefits, coordinate care, and understand and manage their chronic health conditions, such as diabetes, cardiovascular conditions, or cancer.

An important part of a Health Coach’s job is directly reaching out to members to help them navigate their health journey.

“Our outreach is based on risk stratification,” said Diana Lehman, R.N., vice president, Case & Condition Management. “We work with data scientists who are part of our analytics team to identify members who have complex health conditions, such as those who are high-risk for maternal health complications, likelihood for hospitalization, or readmissions.”

Addressing Gaps in Care

Independence Registered Nurse Health Coaches have access to a comprehensive, robust dashboard that provides a wealth of data to help identify gaps in care for members. For example, through the dashboard, our Registered Nurse Health Coaches can see if a member needs an A1C test, which measures blood sugar. While helping the member manage their diabetes, if the member has missed their A1C test, the Health Coach educates them on the importance of the test and works with them to schedule the needed test.

“Our nurses have a lot of valuable information, including claims, pharmacy, and near-real-time data using health information exchange at their fingertips to help members better manage their health,” said Diana. “The dashboard provides a 360-degree view of member data, including if a member is eligible for certain programs or services that we offer, so they can then make the appropriate referrals when needed.”

“Regardless of how a member is identified for engagement, the nurses holistically assist our members, providing education to manage a chronic condition, assisting with transitions of care following an inpatient hospitalization, and providing referrals for behavioral health issues and social determinants of health,” she added.

Nurses Are Making an Impact Behind the Scenes

Behind the scenes at Independence, there are also many nurses who work diligently to ensure that we’re delivering quality care to our members. Nurses work in various departments across the company on critical issues for our members, customers, and provider partners.

Some of the work that our nurses perform includes:

Reviewing, interpreting, and creating medical policies that Independence follows and applies
Reviewing and interpreting data to recommend benefits and offerings to address and best suit the unique needs of our members
Training newly hired nurses in case management and utilization management
Reviewing inpatient hospitalizations against Independence’s medical policy, precertification guidelines, and established medical criteria to perform authorizations
Working with facilities and providers to make sure members are getting the right care at the right time in the most cost-effective setting

Combining Clinical Knowledge and Empathy

Independence thanks our nurses for the important work they perform every day to make our members and communities healthier. Their skills and experience are an invaluable asset.

“Nurses bring empathy to their jobs. But you also need to have clinical knowledge to apply to these roles. It’s imperative,” said Diana. “You can’t train that. You have to come with the clinical background, and then you can do so many roles, while still being able to help people along the way.”

Thank you to our nurses!