Job Description:
• Provides active care management and assesses service needs
• Develops and coordinates action plans in cooperation with members
• Monitors services and implements plans to include member goals
• Evaluates outcomes of plans and documentation of clinical information
• Provides telephonic support for members with chronic conditions
• Participates in direct intervention/patient education with members and providers
• Serves as member advocate and promotes enrollment in care management programs
• Performs medical or behavioral review/authorization process
• Ensures coverage for appropriate services within benefit and medical necessity guidelines
• Maintains current knowledge of contracts and network status of all service providers
Requirements:
• Associates in a job-related field
• Graduate of Accredited School of Nursing OR 2 years job related work experience
• 4 years recent clinical in defined specialty area (e.g., oncology, cardiology, mental health)
• 2 of the 4 years must be clinical
• Working knowledge of word processing software
• Knowledge of quality improvement processes
• Ability to work independently and prioritize effectively
• Good judgment skills
• Demonstrated customer service, organizational, and presentation skills
• Ability to handle confidential or sensitive information with discretion
• An active, unrestricted RN license from the United States and in the state of hire OR
• active compact multistate unrestricted RN license OR
• active, unrestricted licensure as social worker OR
• active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire
Benefits:
• Subsidized health plans
• Dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more