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.
Diversity, Equity, and Inclusion
At AmeriHealth, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At AmeriHealth, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
AmeriHealth 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 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 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 or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.