Job Overview

WellPoint is one of the nation’s leading health benefits companies and a Fortune Top 50 company. At WellPoint, we are working together to transform health care with trusted and caring solutions.

Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine.

Provider Clinical Liasion, RN

 

Managed Care Case Management is highly preferred for this role. Candidates with case management experience not within a managed care organization may not receive first level consideration.

 

Responsible for the Enhanced Personal Health Care program implementation focusing on partnering and building relationships with providers and their office staff to support providers & Enhanced Personal Health Care teams engagement in care management transformation.

Primary duties may include, but are not limited to:

Travel throughout designated territory to meet with large medical groups and providers to discuss Enhanced Personal Health Care management transformation and support those practices.
Serves as the clinical point of contact for the Enhanced Personal Health Care team by facilitating bi-directional communication with our internal care management teams for the management of high risk members
Educate providers & Clinical Coordinators on care management tools to improve adoption of the program within the practice.
Conducts clinical review meetings with physicians, office staff and internal staff.
Serves as the subject matter expert for providers on all Empire Care Management programs for all lines of business and care management programs (i.e. CM, DM, Senior, Nurse Line).
Partners with case/disease management departments to facilitate clinical processes between the company and provider offices Serves as a liaison with state / region provider contracting account managers and other associates.

 

 

  • Current unrestricted State of KY RN license
  • BA/BS/BSN required
  • Managed Care case management strongly preferred.
  • 3-5 years of care management experience (provider or health plan setting required)
  • 2 years of managed care background and case management experience
  • CCM preferred
  • Ability to develop long term relationships, ability to consult with medical groups of all sizes and develop joint action plans
  • Experience with giving group presentations/training
  • Strong business acumen, analytical and persuasion skills required

WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.wellpoint.com/careers. EOE. M/F/Disability/Veteran.