Nurse Advocate - South Carolina

Job Summary

We are seeking an experienced Case Manager to join our growing team and serve as a Nurse Advocate for our new client and their employees. The ideal candidate will be located in South Carolina, have a thorough understanding of the healthcare system, and will be responsible for providing guidance and support to members in navigating the complex healthcare landscape.

Key Responsibilities

• Serve as the primary point of contact for members seeking assistance with navigating the healthcare system.
• Work with members to identify their healthcare needs and provide clinical support.
• Liaison with TPAs and insurance companies to resolve claim and billing issues.
• Educate members on their healthcare benefits and how to effectively utilize them.
• Advocate for members so they can receive improved healthcare outcomes, including referrals to specialists and timely access to care.
• Collaborate with other healthcare professionals, including physicians and nurses to ensure seamless coordination of care.
• Maintain accurate and up-to-date records of member interactions and healthcare interventions.
• Client facing reporting with the potential for limited travel to client worksites.
• Health Risk Assessment review to encourage lifestyle modification and improve overall wellness.

Qualifications

• Active nursing license with a Bachelor of Science in Nursing (BSN) degree preferred.
• Minimum of 3 years of experience as a nurse case manager or in a related healthcare field.
• CCM certification or CCM eligible. Commit to CCM exam within the first year.
• In-depth knowledge of the healthcare and insurance systems.
• Strong analytical and problem-solving skills with the ability to identify and resolve complex healthcare issues.
• Excellent communication and interpersonal skills with the ability to interact effectively with employees and healthcare professionals.
• Ability to work remotely, independently, and as part of a team in a fast-paced, dynamic environment.
• Strong organizational skills with the ability to manage multiple tasks and priorities simultaneously.
• Proficient in the use of electronic health records (EHRs), Outlook, Excel, and other healthcare-related software.