Senior Clinical Services Nurse - AmeriHealth Administrators
- Active PA Licensed Registered Nurse
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Certification in Case Management, preferredMinimum Five years clinical experience (Intensive Care, Trauma, Home Health a plus)Minimum two years medical management experience in the CM and/or UM industry
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Medical management/precertification experience/case management, > or = 1 years of medical management/precertification/retrospective review
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Recent experience or oriented with current body of knowledge, medical practice and care management practices.
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Strong problem solving abilities, organizational and planning skills
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Excellent verbal and written communication skills
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Ability to work independently and provide positive resolution of complex medical and interpersonal challenges
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Highly professional interpersonal skills for internal and external contacts, particularly in situations where medical evaluations are in conflict with treating providers proposed treatment plans.
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Position requires a thorough knowledge of AmeriHealth systems, procedures and policies.
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Personnel Computers Skills/ Windows, Microsoft Office
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Thorough working knowledge of AmeriHealth software systems
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Works to build relations with all providers and provides exceptional customer service
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Participates in the process of educating providers on managed care
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Comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable
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Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy
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Performs additional job-related duties as assigned
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
If you thrive in a dynamic environment and are seeking a career opportunity with substantial growth potential, consider AmeriHealth Administrators. As one of the fastest growing third-party administrators in the country, AmeriHealth Administrators is looking for qualified individuals to join our team.
We use our experience managing more than $1 billion in health benefits to help insurers, employers, producers, health care providers, and members thrive. We have nearly 80 years in the health care industry and over 500 employees with expertise ranging from cost containment and regulatory compliance to specialized processing services and self-funded health plan management.
AmeriHealth Administrators is headquartered in Philadelphia, Pennsylvania.
Equal Employment Opportunity
AmeriHealth Administrators 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 Administrators 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 Administrators 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 Administrators or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.