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.
Provide both proactive outreach and reactive support to members through phone, email, and text.
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.

Spanish fluency (conversational)
Required
You have 1-2 years of experience working at a health plan, preferably with a commercial population.
You have 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. Please include your license number(s) and the corresponding state(s) in your resume.
Diploma from an accredited school/college of nursing required.
You have working knowledge of medical and insurance industry terminology including basic understanding of health plan benefits, CPT/ICD10, authorizations, and digital health programs.
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 experience outreaching and educating members telephonically.
You have 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.

Competitive salary
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

Care Coordinator RN – Bilingual, Spanish

Key skills