Triage Supervisor, Case Management

Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is seeking a Triage Supervisor to join the team! The Supervisor, Triage is responsible for leading a team of clinicians who guide members throughout their healthcare experience by providing tailored support and clinical expertise, in order to elevate the member experience. The team of nurses acts as advocates for our members to help them utilize their health plan to the fullest potential. By educating members on resources and services available to them within their medical benefit plan, your support plays a key role in the member's journey navigating through the complexity and cost of healthcare. The Supervisor leads a team of clinicians who perform symptom triages as well as various health assessments to prevent gaps in care. The Supervisor may also interact with members directly and be a hands-on clinician managing the triage process Position Location:100% Remote

Responsible for managing the team responsible for delivering the clinical triage process and ensuring the member experience is seamless and the members' benefits are utilized to the fullest potential. Responsible for all supervisory duties which could include but not limited to: 1:1 coaching, creating and maintaining team policies and procedures, training of team members, coordinating and support of daily triage activities, maintaining metrics and team statistics as needed, managing staffing schedules, review/approval of team PTO requests, conducting performance reviews, and involvement in hiring and onboarding processes. Lead projects and employee discussions that promote process improvements in the delivery of services within the department. Coordinate and attend meetings throughout the week to maintain project performance. Perform monthly call and chart audits for the triage clinicians. Support member issue and resolution processes as needed. Hands on clinician in the triage process which could include but not limited to: perform real-time symptom triage and appropriate disposition and educational care instructions, using clinical knowledge to provide educational resources to members regarding their medical diagnosis, identify appropriate member referrals to Medical Management programs, resolve gaps in care for members. Collaborate with internal and external stakeholders to ensure a best-in-class service delivery. Adhere to established internal Medical Management policies and procedures, regulations regarding Department of Labor, HIPAA, PHI, and ERISA. Complete and follow HIPAA training/PHI guidelines. Other duties as assigned. Areas of Responsibility: Scope of Practice In addition to performing standard duties, the Registered Nurse is involved in clinical decision making and patient education. The scope of practice for nursing work includes, but is not limited to: Assessment and evaluation of the acquired clinical data to assess the appropriateness of treatment plan based upon Imagine360 clinical guidelines. Coordination of treatment plans, interventions, and outcome measurement. Provide patient education and educational resources. Rationale for the effects of medication and treatments. Accurately report: Client response Contact with other health care team members Evidence-based sources for care plan recommendations Respect the client's right to privacy by protecting confidential information. Promote and participate in education and counseling to a participant based on health needs. Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioners.