The Health Care Advocate – RN is responsible for organizing, coordinating, and providing care coordination and care management services to members with a catastrophic and/or chronic condition who are at risk for health deterioration, sentinel events and /or poor outcomes. The nurse will also perform clinical utilization reviews to determine medical necessity for requested services utilizing corporate policy and/or defined criteria to determine medical necessity and if necessary will consult with the Medical Director for request that do not meet criteria.
- Active, unrestricted, and licensed registered nurse required. Associates degree in health related field required; BSN preferred.
- Three (3) years of clinical RN expererience in a med/surg or ambulatory care setting required. Clinical experience in at least one of the following preferred: Behavior Health, Transplant, Neo-Natal or Oncology.
- Case management certification preferred (CCM). Will be required to obtain case management certificaion (CCM) within three (3) years.
- Previous experience in managed care a plus.
- Clinical knowledge of the health or social work needs for the population served.
- Demonstrated ability to identify barriers to a successful care management path.
- Demonstrated ability to interact effectively with physicians and other members of the health care team.
- Proficient PC and Windows skills required, inlcuding MS Office.
- Excellent problem-solving abilities, couple with solid time management skills.
- Excellent written, verbal and interpersonal communication skills.
- Demonstrated transferable knowledge, skill and ability to complete job duties independently and proficiently. Flexibility in work schedules and assignments.
- Ability to assume responsibility and maintain confidentiality.
- Proven examples of displaying the Nova values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP information