Triage RN - Virtual - CareBridge

Elevance Health•Nashville, TN

23h•Remote

About The Position

This Triage RN - Virtual - CareBridge role is with Carebridge Health, a proud member of the Elevance Health family of companies within the Carelon business. Carebridge Health's mission is 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. Elevance Health is a Fortune 25 health company dedicated to improving lives and communities and making healthcare simpler, focusing on whole health and transforming into a lifetime trusted health partner. The company fosters a culture designed to advance its strategy and promote personal and professional growth for its associates. This is a virtual full-time role, offering maximum flexibility and autonomy, though it may require in-person training sessions when indicated. Candidates must reside within a reasonable commuting distance from the posting locations unless an accommodation is granted. The Triage Nurse I - CareBridge is responsible for determining the appropriate Care Management program for members referred through various internal and external sources and data reports. The role involves utilizing department guidelines and established criteria to complete the triage process and assign members to the correct care management component, focusing on less complex cases with limited or no previous Triage care experience.

Requirements

Active, unrestricted RN Compact license or Multi-state RN licenses in either of the following states: AZ, FL, IA, IN, KS, MA, NM, OH, TN, TX, NJ, HI or VA.
AS in nursing.
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).

Nice To Haves

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.

Responsibilities

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.