Virtual Subrogation Jobs (NOW HIRING)

LOCATION: This position is virtual eligible.

1pm - 11pm CST

10pm - 8am CST

9am - 7pm CST

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.

The Triage Nurse I is responsible for determining the 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 individual's health needs, utilizing plan benefits and community resources.

• Educates members about contracted physicians, facilities and healthcare providers.

• Learn 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 unrestricted RN license in the applicable state(s) required.

Preferred Qualifications

• Current, active, RN Compact license highly preferred.

• Emergency Room and/or Urgent Care experience highly preferred.

• Telehealth experience.

• Experience with EMR systems.

• 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.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $67,200 to $115,920.

Locations: Cleveland, OH; Columbus, OH; Massachusetts; New Jersey; Hawaii, Virginia

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion.