Clinical Services Nurse AHNJ
• Minimum Five years clinical experience (Intensive Care, Trauma, Home Health a plus)
• Minimum two years medical management experience in the UM industry
• Medical management/precertification experience/case management, 2 or more years of medical management/precertification/retrospective review
• Recent experience or oriented with current body of knowledge, medical practice and care management practices.
Education
• Active NJ or PA Licensed Registered Nurse
Skills
• Strong problem solving abilities, organizational and planning skills
• Excellent verbal and written communication skills
• Ability to work independently and provide positive resolution of complex medical and interpersonal challenges
• Highly professional interpersonal skills for internal and external contacts, particularly in situations where medical evaluations are in conflict with treating providers proposed treatment plans.
• Position requires a thorough knowledge of AmeriHealth systems, procedures and policies.
• Strong computers skills- Windows, Microsoft Office
• Thorough working knowledge of AmeriHealth software systems
• Works to build relations with all providers and provides exceptional customer service
• Participates in the process of educating providers on managed care
• Comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable
• Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy
• Performs additional job-related duties as assigned
The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, and skills required.
Vaccination Update
This job requires that you demonstrate you have been fully vaccinated for COVID-19 prior to the start of employment, to the extent permitted by law.
About Our Company
For more than 25 years AmeriHealth New Jersey* has been dedicated to enhancing the health and well-being of the people and communities we serve. Our members are at the center of everything we do. Since the onset of the Affordable Care Act, we have been committed to offering health plans on the Individual Marketplace, which has expanded access to coverage for New Jersey residents. We are exclusively focused on New Jersey with plans designed to meet the unique needs of individuals, small- and mid-sized businesses, municipalities and boards of education across the state. We also provide administrative services to self-funded groups. Named one of the Best Places to Work for the past eight years, and ranked 11th in 2019, AmeriHealth New Jersey is located in Cranbury, NJ. For more information visit amerihealthnj.com.
*AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.
Equal Employment Opportunity
AmeriHealth New Jersey is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an AmeriHealth New Jersey employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth New Jersey and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth New Jersey or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.