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Care Coordination - RN

3 weeks, 6 days ago
United States
Full-time
Mid Level
Operations Specialist
Operations
Salesforce
Apply Now
Evry Health

Evry Health

Evry Health is a modern health insurance company that prioritizes delivering great benefits at affordable prices. They offer a unique approach to health insurance by focusing on making members healthier and happier through personalized care from a dedi...

Insurance
11-50
Founded 2017
$7M raised
View All Jobs 4

Description

  • Communicate with members and providers to educate them on health plan benefits and digital health solutions.
  • Use negotiation and motivational interviewing techniques to improve member engagement.
  • Provide proactive and reactive support through outbound phone, email, and text outreach.
  • Handle difficult calls professionally and document interactions accurately.
  • Track and document work using internal software tools and platforms.
  • Collaborate with supervisors, utilization management, and medical directors to address barriers.
  • Manage escalations with appropriate urgency, communication, accountability, and follow-through.
  • Support coding, medical records/documentation, pre-certification, reimbursement, and claim denials or appeals.
  • Interact with external facilities and providers to gather clinical information for medical necessity reviews and care plans.

Requirements

  • 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 with direct patient care, such as hospital or ambulatory care.
  • Current, unrestricted Texas nursing license or Compact License.
  • Diploma from an accredited school or college of nursing.
  • Working knowledge of medical and insurance terminology, including health plan benefits, CPT/ICD-10, authorizations, and digital health programs.
  • Experience outreaching to and educating members by telephone.
  • Interest or experience in cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, or oncology.
  • Ability to work U.S.-based in the Central or Eastern time zone.
  • Ability to work weekdays 9-5 CST plus rotating on-call weekends.
  • Preferred familiarity with Salesforce, Health Cloud, or CareIQ.
  • Preferred experience working in a call center.
  • Preferred Spanish fluency at a conversational level.

Benefits

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

Interested in this position?

Apply directly on the company website

Apply Now

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