REMOTE: Care Coordination RN

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives. Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.

Evry Health is seeking a tech-savvy Nurse to join our team for Care Coordination. As a Care Coordinator you work with members to improve their wellness and engage with our health plan's benefits. You build good relationships with both our health plan members and our medical providers through phone calls, emails, and texts. This is an exciting role allowing the ability to work with members across the continuum with ~25% utilization review and ~75% care coordination. Our teams are 100% virtual.

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. Pro-active and reactive support for members, including outbound phone/email/text outreach. 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.