Triage Nurse I - CareBridge

Triage Nurse I - CareBridge

Carebridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. Carebridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services.

Location: This position is virtual eligible.

Hours: 9:00 am - 7:00 pm, CST

You will work eight (8) 10-hour work shifts, in a two-week period, which includes Saturday and Sunday every other weekend.

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Triage Nurse I is responsible for determining appropriate Care Management program for members referred through internal and external sources and various data sources and reports. Utilizing department guidelines, completes triage process and applies established criteria to assign members to appropriate care management component. Deals with least complex cases having limited or no previous Triage care experience.

Primary duties may include but are not limited to:

• Utilizes the nursing process to meet an individuals health needs, utilizing plan benefits and community resources.
• Educates members about contracted physicians, facilities and healthcare providers.
• Learns to develop 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 CM and/or DM.
• Partners with social work as appropriate.
• Identifies and refers cases or issues to QI, SIU, Subrogation, Underwriting, or other departments as appropriate.
• Documents appropriate clinical information, decisions, and determinations in a timely, accurate, and concise manner.
• Develops a working knowledge of member benefits, contracts, medical policy, professional standards of practice, and current health care practices.

Required Qualifications

• Requires AS in nursing and minimum of 2 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, valid, active and unrestricted RN license in the applicable state(s) required.

Preferred Qualifications

• You must have a current, unrestricted RN compact license!
• Emergency Room and/or Urgent Care experience highly preferred.
• Telehealth experience is very helpful.
• Experience with EMR systems is preferred.
• BS in nursing preferred.
• Participation and/or certification in a managed care or utilization management organization preferred.
• Ability to understand clinical information and prepare a concise summary following department standards strongly preferred.
• Basic knowledge of the medical management and care management process and role preferred.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: MED > Licensed Nurse