The National Elevator Industry Health Benefit Plan (“Health Plan”), located in Newtown Square, PA (greater Philadelphia area), is currently seeking a Nurse Patient Advocate capable of assisting the Health Plan in improving the quality, affordability and accessibility of healthcare to participants and dependents. The Nurse Patient Advocate will report directly to the Board of Trustees (BOT), but on a day-to-day operational basis will report to the BOT designated representative. The position is full-time and virtual/remote, with some required travel (quarterly board meetings and onboarding). The ideal candidate is expected to be proactive, take initiative and be the leader of the Health Plan’s efforts to improve the quality, affordability and accessibility of healthcare to participants.
The National Elevator Industry Health Benefit Plan provides medical, prescription drug, dental, vision, and hearing benefits to eligible participants and dependents. The Health Plan also provides financial protection through short-term disability benefits and life and accident insurance coverage, a Mental Health and Substance Abuse Benefit and Member Assistance Program (MAP), comprehensive Preventive Care and Wellness services, as well as a Smoking Cessation Program. In addition to the Health Plan, the National Elevator Industry Benefit Plans (“NEIBP”) offer Pension and Annuity benefits to approximately 35,000 members/retirees and 100,000 covered lives. The Pension Plan has assets of approximately $9.5 billion. Please visit www.neibenefits.org/ for more information about NEIBP as well as the Health Plan.
Specific responsibilities include, but are not limited to, the following:
Attend Benefit Committee meetings to present a clinical perspective, review of clinical utilization reports, discuss healthcare services as related to the plan and address concerns from a clinical perspective.
Develop and maintain good working relationships with hospitals and other health care entities to facilitate quality patient health care management.
When appropriate, coordinate with the Plan’s vendors for care coordination with the providers; facilitate patient and family education, discharge planning and follow-up care.
Obtain necessary clinical and treatment plan information from BCBSIL, ESI, Beacon Health Options and providers to facilitate necessary patient care. Act as a liaison between patient, family, nurses, doctors, vendors, and others to facilitate proper and efficient delivery of services to patients.
Potentially develop, coordinate, and attend Health Plan events and patient education programs.
When appropriate, attend participant meetings, including Union meetings.
Oversee utilization and monitor length of stay to assure utilization trends are appropriate in concert with KEPRO.
Investigate, document and report quality issues to appropriate parties.
Act as a plan expert for available network resources.
Educate participants/families on availability of quality providers including Long Term Acute Care, rehab, and skilled nursing facilities.
Develop short-term and long-term healthcare strategies that focus on prevention and early detection of diseases including wellness programs, classes and clinics.
Understand and assist in participant referrals to community resources, including, but not limited to, free services, not-for-profit services and state/county services for patients with chronic diseases.
Educate providers and participants on the in-network clinical resources that are available to them within the Health Plan’s design.
Assist in and monitor specific clinical programs, e.g., Disease Management and Advanced Opioid Management Program, Case Management Programs.
Review of PBM utilization, noting trends of utilization to include formulation of educational interventions for individuals and total group of participants at large, as applicable.
Identify and refer potential candidates for Disease Management, Case Management or other programs that would be beneficial to the overall health of the participant.
Organize educational events to feature subject experts to improve health of participants.
Collaboration with the Plan’s vendors to increase quality of services available to participants.
Review and assist Trustees in adjudicating appeals.
On a monthly basis, review large dollar cases as identified by KEPRO, BCBSIL, Beacon, and ESI with subsequent and routine direct interaction with these participants.
Develop, implement and monitor plans of care for at risk or non-compliant participants from the advocacy standpoint. Measuring markers of achievement and missed opportunities of the interactions.
Record and maintain documentation of individual patient interactions to include advocacy interventions performed and outcomes when possible. These individual interactions must be formulated into an aggregate summary report to demonstrate effectiveness of the advocacy program, which will be maintained by the RN.
Perform other duties as assigned.
The ideal candidate will meet the following requirements:
Work Experience: Minimum of 3 years as a Registered Nurse (RN) with direct patient care experience; preferred experience in a high acuity level i.e. ICU, CC, ER, and/or mental health and substance use, Tele - Health, Telephonic Triage. Prior experience with health plans, self-funded plans, and/or in Taft-Hartley or collective bargaining environment a plus.
Educational Background: Currently must have an unrestricted RN license (this role is virtual/remote with strong preference to residences in PA, NJ. MD, or DE (near Philadelphia)). Minimum of an associate's degree from a two-year technical college or technical school, or diploma nursing program; Bachelor's degree preferred. Certificate as a case manager preferred.
Special Skills or Credentials: Valid Driver’s License and insurance, primary form of transportation required. Excellent organizational, interpersonal, and communication skills (written and verbal). Ability to manage multiple tasks and effectively prioritize various requests and responsibilities. Proactive and positive attitude, always willing to collaborate with team members and colleagues. Ability to thrive in a fast-paced, dynamic, working environment.
The Health Plan offers a competitive salary and a comprehensive benefits package. The Health Plan is an affirmative action employer and encourages applications from all qualified candidates regardless of gender, race, ethnicity, age, sexual orientation, marital status, religion, or disability.
To apply, please send your resume and salary requirements to firstname.lastname@example.org. Please include job reference code 0421NURSECCMC in the subject line or with your application.
Telecommuting is allowed.
Internal Number: 0421NURSECCMC
About National Elevator Industry Health Benefit Plan
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