WellPoint is one of the nations leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to simplify the connection between health, care, and value for our customers.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
**Position located in Indianapolis IN and requires work hours Monday-Friday 11:00am-7:30pm Monday-Friday with no weekends!**
Telephonic RN role responsible for determining appropriate Care Management program for members covered under FEP program and referred through internal and external sources. Position will utilize department guidelines complete triage process and assign members to appropriate care management component.
Primary duties may include but are not limited to:
Educates members about contracted physicians, facilities and healthcare providers.
Ability to handle large volume of telephone inquiries, navigate through multiple systems on PC and verbalize information to member on timely basis.
Demonstrates full knowledge of programs and functional care management and case management roles in order to correctly triage and refer to Enterprise Care Management and other case management roles as appropriate (i.e. Specialty, NICU, Bariatric, Maternity, Oncology, Spinal Cord, and TBM).
Maintains 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 Case Management and/or Disease Management. Partners with social work as appropriate.
Documents appropriate clinical information, decisions, and determinations in a timely, accurate, and concise manner. Strengths knowledge of member benefits, contracts, medical policy, professional standards of practice, and current health care practices.
Requires current unrestricted RN license required in the applicable states, 2 or 3 years acute care clinical experience, and 1 year of medical management or case management experience, or any combination of education/experience which would provide an equivalent background.
WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2012 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.wellpoint.com/careers. EOE
Once an offer is accepted, all external applicants are subject to a background investigation
and if appropriate, drug testing. Offers of employment shall be contingent upon
passing both the background investigation and drug testing (if required).
associate referral process on WorkNet. Official guidelines for the associate referral
- Current WellPoint associates: All referrals must be submitted through the formal
program can be found in My HR.
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