[Remote] Care Coordination (RN) - REMOTE

Note: The job is a remote job and is open to candidates in USA. Evry Health is seeking a tech-savvy Nurse to join our team for Care Coordination. The role involves working with members to improve their wellness and engage with health plan benefits, primarily through virtual communication. This position allows for a blend of care coordination and utilization review responsibilities.

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

Skills

• 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
• 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
• Required to have a dedicated work area established that is separate from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure
• Must live in a location that receives an existing high-speed internet connection/service
• Familiarity with Salesforce/Healthcloud/CareIQ
• Experience working in a call center
• Spanish fluency (conversational)

Benefits

• 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

Company Overview

• Evry Health makes healthcare affordable and high quality again by providing expanded benefits at an affordable price. It was founded in 2017, and is headquartered in Mountain View, California, USA, with a workforce of 51-200 employees. Its website is http://www.evryhealth.com.

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