The NCH Healthcare System – a nationwide leader in healthcare – has an immediate opportunity
for a RN Care Coordinator/Benefits to evaluate high claims within our health plan using evidence-based guidelines in practice, navigating transitions of care, incorporating adherence guidelines and other standardized practice tools.
As the RN Coordinator/Benefits, you will:
- Work closely with the TPA to monitor reporting of high claims to ensure plan of care is medically appropriate and moving forward.
- Evaluate information on members going through the Road to Wellness Program and connect with members with critical values to offer guidance and ensure treatment.
- Review data in Verisk Data Analytic Software prior to contacting the enrollees in the case management program on a regular basis.
- Focus on transitions of care, which includes a complete transfer to the next care setting provider that is effective, safe, timely, and complete.
- Communicate with covered person, physician, family, client, claims administrator, and other case management professionals to utilize available options and services to promote the best medical outcomes.
- Prepare on-going monitoring and reporting of high-claim member status and review a monthly dashboard with the health and wellness team.
- Work closely with the Director and Coordinator of Health and Wellness as it relates to the Road to Wellness outcomes and coordination of new programs.
In addition to a BSN and State of Florida RN licensure (or eligibility), ideal candidates will have two years of case management/care management experience working with a health plan and third party administrator. Two years' experience in a clinical practice within the specialties of rehab, orthopedics, medical/surgical or pediatric nursing is required.
A great place to live and work.
We offer a competitive salary and a comprehensive benefit program that lets you choose the benefits that are important to you. Nestled on the sun drenched beaches of the Gulf of Mexico, Naples is known for its excellent school system, world class shopping, first class dining options, art galleries, numerous championship golf courses, and of course, spectacular sunsets. Boasting beautiful white sand beaches and calm seas, lovely green spaces and recreational facilities, Naples offers something for everyone!
Click here to learn more and apply online.
An Equal Opportunity Employer/Drug Free Workplace