Disease Management Support Nurse

Valenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.

About Our Opportunity

As a Disease Management Support Nurse, you’ll work with our Disease Management team providing initial outreach calls, assignment of cases, and UM support as necessary for patients with specific chronic conditions or diseases. You will work collaboratively to promote quality care and cost-effective outcomes that will enhance the physical, psychosocial, and vocational health of plan participants.

Things You’ll Do Here:

• Assist in the coordination of healthcare services for patients, focusing on specific chronic conditions or diseases.
• Conduct initial calls to members for case management programs and identify individual cases through data mining, precertification, and referrals from various sources.
• Assist Case Management Nurses in Utilization Management (UM) activities for assigned members.
• Advocate for patients' rights, preferences, and needs, aiding them in navigating the healthcare system.
• Collaborate with healthcare professionals to optimize Disease Management strategies.
• Support patients in medication adherence, lifestyle modifications, and arranging follow-up appointments.
• Understand and participate in UM, QA, and complaints/grievances processes, adhere to URAC standards, and follows disaster and safety protocols.
• Interpret plan documents related to service requests and strictly adhere to HIPAA and confidentiality standards.
• Maintain knowledge of relevant regulations and resources, and ensure all activities comply with Federal, State, Local laws, and CMSA’s Standards of Practice
• Adhere to applicable standards, laws, and organizational policies and procedures.
• Deliver exceptional internal and external customer service, contributing to customer development and satisfaction.
• Document all telephonic, fax, or emailed information accurately and comprehensively.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

Where You’ll Work

This is a remote role.

Why You Will Love Working Here

We offer employee perks that go beyond standard benefits and compensation packages – see below!

At Valenz, our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to be strong, vigorous, and healthy. You’ll find limitless growth opportunities as we grow together. If you're ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!

Perks and Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance.
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting.
• Flexible working environment.
• Generous Paid Time Off to include Vacation, Sick, and Paid Holidays.
• Paid maternity and paternity leave.
• Community giveback opportunities, including paid time off for philanthropic endeavors.

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.

What You’ll Bring to the Team:

• 3+ years of experience in a related healthcare setting, preferably with exposure to Disease Management.
• Active LPN/LVN License - unrestricted to practice in the state of primary residence - compact license preferred.
• Experience in a deadline driven environment with a knack for organization and detail.
• Ability to comprehend the consequences of various problem situations and to refer such problems to the appropriate individual (or supervisor) for decision-making.
• Excellent communication skills to liaise between patients, families, and healthcare professionals.
• Patience and resilience, especially when faced with challenging situations.

A plus if you have:

• Disease Management Support experience.
• Additional state licensures.