REMOTE: Registered Nurse Integrated Care Coordinator (Care Coordination and Utilization Review)

Evry Health is seeking an Integrated Care Coordinator Nurse to join our team. You will provide comprehensive care coordination services and be responsible for quality outcomes for our members. The care coordinator strives to ensure a positive member experience, build good relationships with members, providers, and facilities to ensure Evry Health is a reliable and trusted partner in member care.

You will have direct impact in development of care management and utilization management processes to improve member outcomes. Coordinating healthcare services may include but not limited to monitoring members’ use of healthcare services, linking members to healthcare services, assist in navigating services, assist with addressing barriers to both behavioral health and medical services, and follow up on any concerns relevant to healthcare provided. If you enjoy working in a fast-paced tech savvy environment, are self-motivated to creatively problem solve, and improve health outcomes then this is a role for you!

Background

Evry Health is a startup technology company and health insurer, backed by Y Combinator and several Silicon Valley venture capital funds. We build better health insurance for mid-size businesses and their employees, that costs up to 20% less. The company’s goal is to provide innovative health insurance solutions that emphasizes the development of population health care and health management. We offer digital first programs to support members with acute and chronic conditions, prevention and wellness programs, integrated care, behavioral health, and pharmacy management solutions.

When you join Evry Health, you will benefit from a culture of teamwork, innovation, and growth. As an Integrated Care Coordinator, you’ll help members and providers navigate the complex healthcare system, in a compassionate and supportive manner.

Roles and Responsibilities

• Proactively advocates, coordinates, and communicates to assist all members with identifying and navigating digital first solution care programs, healthcare services and community resources; providing the most appropriate solutions while encouraging them to become self-sufficient with our tools.
• Researches, reviews, documents, and responds to inquiries received about care programs, authorization, and appeal requests.
• Employs active listening & motivational interviewing skills; handles difficult calls tactfully, courteously, and professionally.
• Effectively manages escalations within the department by ensuring appropriate accountability, communication and follow through to closure.
• Contributes to the development of processes and implementation of care plans.
• Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations.
• Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins.

Experience and Skills Desired

• You have a minimum of three years’ case management and three years’ utilization review experience within an insurance health plan or hospital system.
• You have working knowledge of medical and insurance industry terminology including basic level CPT/ICD10, authorizations, digital health programs, and NCQA/URAC standards.
• You are comfortable building, documenting and improving upon new and existing care coordination processes.
• You can work independently and comfortable in a fast-paced, deadline-oriented work environment.
• You have an area of interest or experience within cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology.
• You have an innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system.
• Experience working in a virtual environment.
• Bonus: fluency in Spanish.
• Bonus: Healthcloud/Salesforce/CareIQ experience.
• Bonus: startup company experience.

Telecommuting Requirements

• 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.

Location and Benefits

• This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
• Full benefits package including health insurance, 401(k) matching, vision, dental, life, disability, vacation, and stock options.

Employment Status

Full time salaried position with on call responsibilities (weekends and evenings)

Job Category

Nursing - Integrated Care Management

Education & License Requirements

• Texas RN license or temporary TX RN license, should obtain permanent license within 30 days. Compact license acceptable according to current Board of Nursing requirements
• American Nursing Credentialing Center (ANCC)-recognized certification, Case Management-related, including but not limited to Certified Case Manager (CCM), American Case Management Association - Accredited Case Manager (ACMA-ACM), or Certified Managed Care Nurse by AAMCN or Care Coordination & Transition Management Certification (CCTM)

Notice

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description.