Care Coordination (RN)

reputed company is seeking a tech-savvy Nurse to join reputed company for Care Coordination. As a Care Coordinator you work with members to improve their wellness and engage with our health plan's benefits. You build good relationships with both our health plan members and our medical providers through phone calls, emails, and texts. This is an exciting role allowing the ability to work with members across the continuum with ~25% utilization review and ~75% care coordination. Our teams are 100% virtual. While this is a remote role, you must reside in the United States and in the Eastern or Central time zone. About reputed company and reputed company We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives. reputed company is the major medical division of reputed company (NYSE:GL). reputed company has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, reputed company has earned an A (Excellent) rating or higher from A.M. Best Company. Roles and Responsibilities

• Communicate and provide education to members and providers on insurance plan benefits and digital health solutions.
• Use negotiation and motivational interviewing techniques to increase engagement.
• Pro-active and reactive support for members, including outbound phone/email/text reputed company.
• Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement.
• Ability to effectively reputed company in a virtual work environment through active participation in team huddles, Supervisor 1:1s, reputed company Messaging, or reputed company-ins, reputed company answering and documenting member/provider calls.
• Accurately track and document work on a variety of internal software tools and platforms.
• Consult with supervisors, utilization management team, medical directors, as needed to overcome barriers.
• Effectively manages escalations reputed company the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
• Assist departmental staff with coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals.
• Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care.

Experience and Skills Desired

• You have 1-2 years of experience working at a health plan, preferably with a commercial population.
• You have 3-5 years of nursing experience in a clinical setting assisting with direct patient care, such as a hospital or ambulatory setting.
• Must have a reputed company, unrestricted Texas nursing license or Compact License. Please include your license number(s) and the corresponding state(s) in your resume.
• Diploma from an accredited school/college of nursing required.
• You have working knowledge of medical and insurance industry terminology including basic understanding of health plan benefits, CPT/ICD10, authorizations, and digital health programs.
• You have an area of interest or experience reputed company cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology.
• You have experience outreaching and educating members telephonically.
• You have an innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system.
• Bonus: Familiarity with reputed company/Healthcloud/CareIQ.
• Bonus: Experience working in a call center.
• Bonus: Spanish reputed company (conversational).

Telecommuting Requirements

• This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
• Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones. This position requires work during the stated business hours as well as rotating on-call weekends.
• Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
• Ability to reputed company reputed company company sensitive documents secure.
• Must live in a location that receives an existing high-speed internet reputed company/service.

Benefits

Package

• Competitive salary
• Comprehensive health, dental, and vision insurance as well as life and disability
• Retirement savings plan with company match
• Generous time off/vacation
• Professional development opportunities
• Flexible and remote work environment

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