Role Description

This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Triage Nurse I - CareBridge is responsible for determining the appropriate Care Management program for members referred through internal and external sources and various data sources and reports. Utilizing department guidelines, completes triage process and applies established criteria to assign members to appropriate care management component. Deals with least complex cases having limited or no previous Triage care experience.

• Utilizes the nursing process to meet an individual’s health needs, utilizing plan benefits and community resources.
• Educates members about contracted physicians, facilities and healthcare providers.
• Develops favorable working partnerships and collaborative relationships with members, physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members.
• Works in collaboration with medical management and care management associates to identify issues, problems, and resource needs and assign to appropriate care management program.
• Facilitates selecting appropriate candidates for referral to CM and/or DM.
• Partners with social work as appropriate.
• Identifies and refers cases or issues to QI, SIU, Subrogation, Underwriting, or other departments as appropriate.
• Documents appropriate clinical information, decisions, and determinations in a timely, accurate, and concise manner.
• Develops a working knowledge of member benefits, contracts, medical policy, professional standards of practice, and current health care practices.

Qualifications

• Requires AS in nursing and minimum of 2 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current unrestricted RN license in the applicable state(s) required.

Requirements

• Current, active, RN Compact license highly preferred.
• Emergency Room and/or Urgent Care experience highly preferred.
• Telehealth experience.
• Experience with EMR systems.
• BS in nursing preferred.
• Participation and/or certification in a managed care or utilization management organization preferred.
• Ability to understand clinical information and prepare a concise summary following department standards strongly preferred.
• Basic knowledge of the medical management and care management process and role preferred.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).