Apply on Employer Site

Evry Health · 2 hours ago

Care Coordination (RN) - REMOTE (EST or CST)

United States

Full-time

Remote

Mid Level

3+ years exp

Evry Health is seeking a tech-savvy Nurse to join our team for Care Coordination. As a Care Coordinator, you will work with members to improve their wellness and engage with our health plan's benefits, focusing on building relationships with health plan members and medical providers.

Health CareHealth InsuranceInsurancePersonal Health

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 outreach

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 excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently 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 within 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

Qualification

Nursing licenseCare coordinationUtilization reviewMedical terminologyPatient educationMotivational interviewingSalesforce familiaritySpanish fluencyActive listeningCommunication skills

Required

1-2 years of experience working at a health plan, preferably with a commercial population

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 current, unrestricted Texas nursing license or Compact License

Diploma from an accredited school/college of nursing required

Working knowledge of medical and insurance industry terminology including basic understanding of health plan benefits, CPT/ICD10, authorizations, and digital health programs

Area of interest or experience within cardiology/pulmonology, women's health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology

Experience outreaching and educating members telephonically

Innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system

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 within 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