Care Coordination Registered Nurse

Care Coordination Registered Nurse at Evry Health

Evry Health is actively seeking a tech-savvy Registered Nurse to join our Care Coordination team. In this pivotal role, you will collaborate with members to enhance their overall wellness and maximize their engagement with our health plan's comprehensive benefits. You'll cultivate strong relationships with both members and medical providers through various communication channels, including phone calls, emails, and texts. This exciting position offers a balanced workload, dedicating approximately 25% of your time to utilization review and 75% to direct care coordination. Our teams operate in a fully virtual environment, requiring candidates to reside within the United States, specifically in the Eastern or Central time zone.

About Evry Health and Globe Life

We are driven by a mission to infuse humanity back into health insurance. Our advanced technology health plans are designed to expand benefits, improve access and transparency, and deliver a personalized, human-centric approach. Our ultimate goal is to empower members to lead happier, healthier lives. Evry Health operates as the major medical division of Globe Life (NYSE:GL), a venerable institution boasting 16.8 million policies in force and a workforce of over 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has consistently achieved an A (Excellent) rating or higher from A.M. Best Company.

Roles and Responsibilities

• Communicate and provide education to members and providers regarding insurance plan benefits and digital health solutions.
• Utilize negotiation and motivational interviewing techniques to increase member engagement.
• Provide proactive and reactive support for members, including outbound phone, email, and text outreach.
• Employ active listening and motivational interviewing skills to handle difficult calls tactfully, courteously, and professionally, ensuring thorough documentation to build patient trust and engagement.
• 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, the utilization management team, and medical directors as needed to overcome barriers and ensure optimal care.
• Effectively manage escalations within the department by ensuring appropriate accountability, a strong sense of urgency, clear communication, and follow-through to closure.
• Assist departmental staff with coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals.
• Interact with external facilities or providers as needed to gather clinical information that supports the medical necessity review process and plan of care.

Experience and Skills Desired

• 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 possess a current, unrestricted Texas nursing license or Compact License. Please ensure your license number(s) and corresponding state(s) are included in your resume.
• Diploma from an accredited school/college of nursing required.
• Working knowledge of medical and insurance industry terminology, including a basic understanding of health plan benefits, CPT/ICD10, authorizations, and digital health programs.
• An 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.
• An innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system.
• Bonus: Familiarity with Salesforce/Healthcloud/CareIQ.
• Bonus: Experience working in a call center.
• Bonus: Spanish fluency (conversational).

Telecommuting Requirements

• This is a remote position; our entire company operates virtually.
• Company headquarters are located in Dallas, Texas.
• Company business hours are weekdays 9 AM - 5 PM CST.
• We will only consider candidates in the United States who reside in the CST or EST time zones.
• 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.

Benefits Package

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

Key skills/competency

• Care Coordination
• Registered Nurse (RN)
• Utilization Review
• Motivational Interviewing
• Health Plan Benefits
• Clinical Nursing
• Telephonic Outreach
• Patient Engagement
• Medical Terminology
• Salesforce