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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, and hyperlipidemia but not limited to this list.
Job Responsibility:
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
Requirements:
Graduation from an accredited RN program and possession of a current United States RN license
Prior experience in case management, coordinating wellness programs, or an equivalent combination of education and experience
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
What we offer:
Comprehensive medical and dental coverage
Mental health support and wellness programs
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 like Critical Illness and Hospital Indemnity coverage
Professional development opportunities and clear career progression paths