Job Description
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Role Description
- As a Full-Time Disease Management Nurse, you will telephonically coordinate wellness and disease management, with a primary focus on conditions such as:
- Diabetes
- Asthma
- COPD
- CAD
- CHF
- Atrial fibrillation
- Hypertension
- Hyperlipidemia
- What You'll Actually Do:
- Contact targeted member for health promotion and restoration by the use of national care guidelines to compare patient’s current level of care with industry standards.
- Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health; create an individual care plan for each patient; provide close follow-up with patients actively managed.
- Work with patients to ensure they have a primary care provider; assist in referrals to specialists if needed; assist in obtaining durable medical equipment, review pricing for high-cost drugs.
- Evaluate and make referrals for case management, prenatal program or pharmacology review as indicated.
- Document interventions and patient contact; maintain privacy of member’s records and assist in providing quarterly reports to clients.
- Track groups of high-risk members and interventions to show overall health improvement within the organization.
- Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
- Qualifications
- Graduation from an accredited RN program and possession of a current United States RN license. May require additional licensing as business needs change.
- Prior experience in case management, coordinating wellness programs, or an equivalent combination of education and experience.
- Requirements
- Strong written and verbal communication skills
- Proficient in Microsoft Excel, Word, PowerPoint and Outlook
- Demonstrate ability to work independently with excellent judgment
- Excellent interpersonal and communication skills including able to give presentations to groups and individuals as needed.
- Good time management skills, highly organized.
- Benefits
- Comprehensive medical and dental coverage through our own health solutions
- Mental health support and wellness programs designed by experts
- Flexible work arrangements
- Retirement planning support
- Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection
- Employee savings programs and voluntary benefits
- Professional development opportunities and clear career progression paths
- Mentorship from industry leaders
- Learning budget to invest in skills
- Competitive base salary
- PTO policy
- Benefits effective day one
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