Nurse Coordinator: AvMed Health Plans

Position Summary:

Utilization Management

Provides Member medical utilization management by utilizing Clinical Assessment skills, and approved clinical criteria to assist provider with authorization of appropriate medical treatment in the appropriate medical setting.

Member Demand Management

Registered Nurse who is responsible for supporting the sponsor's services through inbound and outbound telephonic interactions with AvMed Members and providers calling on behalf of Members. Responsible for telephonic medical management, ER encounters, and urgent after-hours provider service request for all AvMed Members. Utilizes Clinical Assessment and Education Guidelines to assess the caller's symptoms and to provide them with healthcare and education. The Coordinator guides the caller to access the healthcare system at the most appropriate level of care. Provides a high level of objective information to callers enabling them to work most effectively with the physician and other providers. The goal is to empower callers to make informed decisions about major medical procedures or treatments and to assist them in managing chronic conditions. Utilizes the five (5) essential case management functions of assessment, planning, implementation, coordination and evaluation in an effort to promote timely, appropriate, and cost effective care.

Education/Experience Requirements:

Registered Nurse with a current Florida license. Minimum of three (3) to five (5) years hospital, Emergency department, or clinical experience involving substantial public contact preferred. Tele-Health triage or Call Center experience preferred. Knowledge of basic community resources. Basic counseling skills. Superior nursing expertise. Basic computer knowledge. Excellent verbal and writing skills. Pleasant telephone voice. Positive, enthusiastic and helpful personality. Self-directed and critical thinking competence. Work effectively with minimal supervision. Organized and able to set priorities.

AvMed Health Plans is a Drug/Tobacco-Free Workplace, EOE.