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
About Our Company
AmeriHealth Administrators is one of the largest national third-party administrators providing innovative, value-based health benefits programs and outsourcing services for self-funded health plans and other organizations.
The company also provides customized outsourcing services for TPAs and other payers, student health plans, and fully insured products.
AmeriHealth Administrators serves 1 million plan members in all 50 states and processes over 6 million claims annually.
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.