Triage RN

Imagine360 is currently seeking Triage RN to join our Medical Management team! The Triage RN guides members throughout their healthcare experience by providing tailored support and clinical expertise. The nurse acts as an advocate for our members to help them utilize their health plan to the fullest potential. By educating members on resources and services available to them within their medical benefit plan, your support plays a key role in the member's journey navigating through the complexity and cost of healthcare. The Triage RN performs symptom triage as well as various health assessments to prevent gaps in care. The nurse also assists our newest members to ensure a smooth transition into their health plan. Interactions with members will demonstrate an ability to understand and act upon a member's needs to elevate the Member Experience.

The schedule for this role is:

Monday - Thursday: 12pm - 9pm CST

Friday: 10am - 7pm CST

Position Location: 100% Remote

Responsibilities include but are not limited to:

• Deliver best-in-class service via phone and email by acting as a single point of contact and maintaining ownership of member resolution.
• Utilize clinical knowledge, expertise, and Imagine360 approved educational resources to provide verbal and/or written educational resources to members regarding medical diagnosis, procedures and/or treatments.
• Perform real-time symptom triage to provide an appropriate disposition and educational care instructions, as needed.
• Review and assess current medical treatment and history to identify appropriate member referrals to Medical Management Programs.
• Assess members at various points in their health care journey to ensure appropriate support and resolve any gaps in care.
• Anticipate the needs of members and conduct research on members' behalf to resolve issues.
• Communicate proactively and effectively with members, peers, leadership, and all stakeholders.
• Collaborate with internal and external partners to ensure a best-in-class service delivery.
• Accurate documentation in appropriate software in compliance with established Policy and Procedures.
• Provide Reference Based Pricing education and coordination to the member and/or provider.
• Attend scheduled and periodic meetings, trainings and other job specific events as required by teleconference.
• Adhere to established internal regulations regarding Department of Labor, HIPAA, PHI, ERISA and Medical Management Policy and Procedures.
• Resolve member complaints.
• Work scheduled shifts for coverage between the hours of 7:00am-9:00pm CST.
• Other duties as assigned.
  
  
  

Areas of Responsibility: Scope of Practice

In addition to performing standard duties, the Registered Nurse is involved in clinical decision making and patient education. The scope of practice for nursing work includes, but is not limited to:

• Assessment and evaluation of the acquired clinical data to assess for appropriateness of treatment plan based upon Imagine360 clinical guidelines.
• Coordination of treatment plans, interventions, and outcome measurement.
• Provide patient education and educational resources.
• Rationale for the effects of medication and treatments.
• Accurately report:
• Client response
• Contact with other health care team members
• Administration of medication and treatments
• Respect the client's right to privacy by protecting confidential information.
• Promote and participate in education and counseling to a participant based on health needs.
• Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioner.
  
  
  

Qualifications/Education:

• Graduation from an Accredited School of Nursing.
• Active and unrestricted Registered Nurse License in eNLC compact state.
• 1+ years of clinical nursing experience, either experience in direct patient care or telephonic clinical care
  
  
  

Requirements:

• Excellent communication skills with personable and approachable demeanor and a passion for serving others.
• Experience in a clinical environment such as in a Hospital, Physician's Office, or similar.
• Maintain active Registered Nurse license and CEU's as required by the State Board of Nursing.
• Team player who builds effective working relationships and able to handle multiple tasks & assignments.
• Proficient in typing and Office Software (Word, Excel, PowerPoint) and other programs such as Outlook, Internet Explorer, Database software, and standard office equipment.
• Ability to work independently in a home office environment.
• Ability to read and interpret documents such as HIPAA compliance, safety rules, operating and maintenance instructions, and policy & procedure manuals.
• Ability to draft professional communications and articulate complex ideas clearly in writing.
• Ability to write routine reports and correspondence.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. Ability to apply concepts of basic mathematics and accounting principles.
  
  
  

License and/or Certificates:

• Must maintain active, current, and unrestricted Registered Nurse license and CEU's as required by the State Board of Nursing. Must be willing to obtain and maintain additional license(s) as required to perform the job functions of the organization
  
  
  

What can Imagine360 offer you?

• 100% Employee paid medical benefits including, medical, vision and dental
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives
  
  
  

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**