Triage Nurse I - CareBridge

Elevance Health•St. Louis, MO

3d•Remote

About The Position

Carebridge Health, a member of the Elevance Health family of companies within Carelon, focuses on enabling individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community-based services. This virtual position requires candidates with an active, unrestricted RN Compact license or Multi-state RN licenses in specific states (AZ, FL, IA, IN, KS, MA, NM, OH, TN, TX, NJ, HI, or VA). The role involves working eight 10-hour shifts over a two-week period, including every other weekend. While primarily virtual, there may be required in-person training sessions. The Triage Nurse I is responsible for determining the appropriate Care Management program for members referred through various sources. This involves utilizing department guidelines, completing the triage process, and applying established criteria to assign members to the correct care management component. This role typically handles less complex cases and may involve individuals with limited prior triage experience. Primary duties include using the nursing process to address health needs, educating members about benefits and providers, developing collaborative relationships with stakeholders, identifying issues and resource needs, facilitating referrals to care and disease management programs, partnering with social work, and referring cases to other departments (QI, SIU, Subrogation, Underwriting) as needed. Accurate and timely documentation of clinical information, decisions, and determinations is essential. The nurse will also develop a working knowledge of member benefits, contracts, medical policy, professional standards, and current healthcare practices.

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, valid, active and unrestricted RN license in the applicable state(s) required.
Active, unrestricted RN Compact license, or Multi-state RN licenses, in any of the following states: AZ, FL, IA, IN, KS, MA, NM, OH, TN, TX, NJ, HI or VA.

Nice To Haves

Emergency Room and/or Urgent Care experience highly preferred.
Telehealth experience is very helpful.
Experience with EMR systems is preferred.
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.

Responsibilities

Utilizes the nursing process to meet an individuals' health needs, utilizing plan benefits and community resources.
Educates members about contracted physicians, facilities and healthcare providers.
Learns 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.