Holistic Health Specialist - Work From Home

About the role

This position is responsible for performing a variety of functions and is a single source of contact for members, health care personnel and all other entities involved in managing care. Identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual’s health needs. Promotes quality and cost-effective outcomes; and serves as liaison to physicians and members.

Responsibilities

• Determining member assignment of treatment
• Pre-admission/post-discharge counseling for an acute condition
• Establishing relationships with members
• Handling immediate post discharge follow-up or until all short-term care needs are met
• Providing education/local resource information and encouraging member (self) education
• Functioning in a clinical care advisory role, assessing members for wellness education and disease management, introducing members to our website tools, educating members regarding wellness and specific conditions, and facilitating the coordination of care for identified members

Requirements

• Registered Nurse (RN) with current, valid, unrestricted license in state of operations
• 2 years of clinical practice experience of direct clinical care to the customer
• 1 year of experience in care management/condition management in a health insurance/managed care setting
• PC proficiency to include Word, Excel, Lotus Notes and database experience
• Clear and concise verbal and written communication skills
• Familiarity of ancillary services including HHC, SNF, Hospice, etc
• Analytical skills
• Decision making skills and sound clinical judgment to provide oversight of other staff

PREFERRED JOB REQUIREMENTS

• Must have an active and unrestricted Compact Nursing license
• Case Management experience is needed
• Experience in managing complex or catastrophic health cases
• Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)
• Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree
• Knowledge of Milliman Guidelines or similar clinical guidelines
• Knowledge of medical management policies and procedures

Benefits

Commensurate with experience.

Pay

$61,500.00 - $136,100.00

Schedule

Central Standard Time Zone (9:30 AM to 6 PM CST Monday through Friday)