Triage RN

Responsibilities

• Perform real-time symptom triage and appropriate disposition and educational care instructions.
• Provide educational resources to members regarding their medical diagnosis.
• Identify appropriate member referrals to Medical Management programs.
• Resolve gaps in care for members.
• Maintain monthly performance metrics.
• Utilize clinical knowledge, expertise, and Imagine360 approved educational resources to provide verbal and/or written educational resources to members.
• Review and assess current medical treatment and history to identify appropriate member referrals to Medical Management Programs and resolve any gaps in care.
• Collaborate proactively and effectively with members, peers, leadership, and all stakeholders to ensure a best-in-class service delivery.
• Accurate documentation in appropriate software in compliance with established Policy and Procedures.
• Adhere to established internal regulations regarding Department of Labor, HIPAA, PHI, ERISA and Medical Management Policy and Procedures.
• Resolve member complaints.
• Work scheduled shifts for coverage between the hours of 7:00am-9:00pm CST.
• Attend scheduled and periodic meetings, trainings and other job specific events as required by teleconference.
• Other duties as assigned.

Qualifications

• A nursing degree from an accredited college, university, or school of nursing.
• Active and unrestricted Registered Nurse License in eNLC compact state.
• 1+ years of clinical nursing experience, either experience in direct patient care (Hospital, Physician's Office, or similar) or telephonic clinical care. Experience in a telephonic clinical role preferred.