HealthEdge
1001 - 5000 employees
Founded 2005
🏥 Healthcare
💼 Consulting
⚕️ Healthcare Insurance
Healthcare • Consulting • Healthcare Insurance
HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.
RN, Behavioral Health
🔥 7 minutes ago
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HealthEdge
1001 - 5000 employees
Founded 2005
🏥 Healthcare
💼 Consulting
⚕️ Healthcare Insurance
Healthcare • Consulting • Healthcare Insurance
HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.
📋 Description
• Telephonic coordination and delivery of clinical behavioral health services • Utilize clinical experience and skills in collaborative assessments and care coordination • Review, research and authorize requests for healthcare services • Contact medical personnel for treatment alternatives • Analyze and prepare documentation for retrospective review requests and appeals • Establish and communicate discharge planning needs • Develop and deliver targeted education for provider community
🎯 Requirements
• Registered Nurse with current unrestricted Registered Nurse license required • Certification in Case Management may be preferred • 2+ years of acute clinical experience as RN required • One (1) year health insurance plan experience or managed care environment preferred • 1+ years Behavioral Health clinical experience • 1+ years Managed Care of Utilization Management experience
🏖️ Benefits
• Health insurance • Continuously learning and development opportunities
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