Triage Nurse I - Carebridge

Title: Triage Nurse I - Carebridge

Location: Massachusetts United States

Job Description:

Position Title:

Job Description:

Seeking candidates who have an active, unrestricted RN Compact license or Multi-state RN licenses in either of the following states: AZ, FL, IA, IN, KS, MA, NM, OH, PA, TN, TX or VA.

Carebridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. Carebridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services

Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Work Shift: Eight (8)10-hour work shifts, 7am - 5pm (Central Standard Time) in a two-week period, including Saturday and Sunday every other weekend.

The Triage Nurse I - Carebridge is responsible for determining the appropriate Care Management program for members referred through internal and external sources and various data sources and reports. Utilizing department guidelines, completes triage process and applies established criteria to assign members to appropriate care management component. Deals with least complex cases having limited or no previous Triage care experience.

Primary duties may include but are not limited to:

• Utilizes the nursing process to meet an individual's health needs, utilizing plan benefits and community resources.
• Educates members about contracted physicians, facilities and healthcare providers.
• Learn to develop favorable working partnerships and collaborative relationships with members, physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members.
• Works in collaboration with medical management and care management associates to identify issues, problems, and resource needs and assign to appropriate care management program.
• Facilitates selecting appropriate candidates for referral to CM and/or DM.
• Partners with social work as appropriate.
• Identifies and refers cases or issues to QI, SIU, Subrogation, Underwriting, or other departments as appropriate.
• Documents appropriate clinical information, decisions, and determinations in a timely, accurate, and concise manner.
• Develops a working knowledge of member benefits, contracts, medical policy, professional standards of practice, and current health care practices.

Position requirements:

• Requires AS in nursing and minimum of 2 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current unrestricted RN license in the applicable state(s) required.

Preferred qualifications, skills, and experiences:

• Current, active, RN Compact license highly preferred.
• Emergency Room and/or Urgent Care experience highly preferred.
• Telehealth experience.
• Experience with EMR systems.
• BS in nursing preferred.
• Participation and/or certification in a managed care or utilization management organization preferred.
• Ability to understand clinical information and prepare a concise summary following department standards strongly preferred.
• Basic knowledge of the medical management and care management process and role preferred.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

MED > Licensed Nurse

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.