[Remote] Care Coordination (RN) - REMOTE

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a tech-savvy Nurse to join reputed company 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 reputed company of care coordination and utilization review responsibilities.

Responsibilities

• Communicate and reputed company education to members and providers on insurance plan benefits reputed company 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
• reputed company 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

Skills

• 1-2 years of experience working at a health plan, preferably with a reputed company 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 reputed company, 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, reputed company health programs
• Area of interest or experience reputed company 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 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
• 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
• Familiarity with reputed company/Healthcloud/CareIQ
• Experience working in a call center
• Spanish reputed company (conversational)

Benefits

• Comprehensive health, dental, and reputed company 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

• reputed company makes reputed company 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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