AmeriBen is a proud member of the Elevance Health family of companies. We are a third-party administrator (TPA) of medical benefits, also providing medical management, human resource consulting and retirement benefits administration services.

M-F including 2-3 evening shifts

Job Purpose

Health Management Registered Nurses are dedicated to superior health coaching services to maximize each member’s capacity for self-care, to cost effectively achieve desired clinical outcomes, and to enhance quality of medical care. They are dedicated to ensuring that members have the resources and knowledge to live a healthy lifestyle. It is characterized by advocacy, communication, and support management, while promoting quality enhancement outcomes. The health coach’s role includes contact with the participant and/or provider(s) for coordination of services within the health care arena.

Key Functions

• Completes weekly outbound cold calls to reach sufficient active member list.
• Establishes contact with member and develops, implements, and evaluates individualized member care plan.
• Establishes contact with member and develops, implements, and evaluates individualized member care plan.
• Acts as a liaison between referral source, physician, and member to coordinate appropriate cost- effective recommendations.
• Conducts post Emergency calls.
• Acts as a liaison between referral source, physician, and member.
• Assesses the member’s status, prognosis, future care needs, treatment plan and alternative treatment plans.
• Evaluates effectiveness of care plan, tracks patient compliance to clinical guidelines/plan, and documents progress towards goals.
• Utilizing motivational interview techniques, conduct telephonic health assessments and provide appropriate education and clinical inventions to members in multiple disease populations by developing a care plan.
• Empower members to take care of their health by adopting good diet, exercise and healthy lifestyle habits.
• May train in specialized programs (i.e., Maternal Health or Wellness/Tobacco Cessation).
• Maintains and report applicable statistics regarding programs and patient services.
• Identifies members for referral opportunities to integrate with other services (i.e., Case Management, Utilization Management).
• Maintains appropriate documentation and records cost management.
• Attends on-site weekly company/team meetings and monthly staff meetings.
• Ensure compliance with security practices and procedures, including HIPAA and HITRUST standards.
• Protects and enhances the daily culture and environment of AmeriBen. Fosters, supports, and demonstrates the company Core Purpose and Core Values.
• Performs all duties within the scope of licensure.
• Performs other duties as assigned or needed.
• Ability to efficiently and effectively perform the Key Function Areas with or without a reasonable accommodation without posing a direct safety threat to others or self

Required Experience:

Minimum Qualifications & Education

• Current unrestricted R.N. license
• Associates Degree in Nursing (Bachelor’s degree is preferred).
• Minimum of two years of clinical experience.
• Knowledge of medical/health insurance terminology, ICD-10/ICD-11, HIPAA and DOL regulations.

Preferred Qualifications

• Diverse clinical experience preferred.
• Clinical experience in Health Management, Wellness Coaching, and/or Maternal Health preferred.
• Understanding of Health Management, Wellness, and Maternal Health functions, self-funded insurance plans and PPO networks.
• Motivational Interviewing and health coaching experience preferred.
• Previous telephonic/telehealth experience in health care.

AmeriBen will adopt Elevance Health’s HR policies effective January 1, 2023. AmeriBen associates hired prior to December 19, 2022, will have at least 60 days to meet the vaccine or accommodation requirements under Elevance Health’s vaccine policy once it becomes effective January 1, 2023. Elevance Health will also follow all relevant federal, state, and local laws.

AmeriBen associates hired December 19, 2022, and beyond require immediate compliance to the Elevance Health vaccination policy. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state, and local laws.

AmeriBen is an Equal Opportunity Employer committed to creating an environment of diversity and inclusion for equal employment and advancement opportunities to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, national origin, sex, sexual orientation, gender identity and/or expression, genetic information, disability, veteran or military status, or any other category protected by federal, state and/or local law.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. If you are unable to use our online application process due to a disability, please contact the Human Resources Department at humanresources@ameriben.com or call 208-488-7654.
From: AmeriBen