Role Summary
The RN Integrated Care Coordinator is a core clinical contributor delivering comprehensive, member-centered care coordination across the care continuum for Evry Health's fully insured commercial health plan population. The role combines proactive and reactive member engagement, and individualized care planning in a fully remote, technology-forward environment.
Roles and Responsibilities
- Proactive & Reactive Member Engagement: Conducts outreach based on risk stratification and care gap data, and responds to member/provider contacts, using motivational interviewing to build trust and drive benefit and program engagement.
- Care Plan Development & Coordination: Conducts comprehensive clinical, psychosocial, and SDOH assessments and develops individualized care plans, monitoring progress and coordinating resources across the care continuum.
- Member & Provider Education: Educates members and providers on benefits, digital health solutions, and evidence-based self-management strategies, translating complex information into clear, actionable guidance.
- Utilization Review Support: Serving as the communication bridge between the UM team, providers, and members to ensure members get the right care at the right place of service.
- Documentation, Escalation Management & Digital Health Promotion: Accurately documents all care coordination and UM support activity, manages escalations to appropriate clinical resources, and promotes member enrollment in Evry Health's digital health programs.
Qualifications
- Diploma from an accredited school of nursing required; ADN or higher preferred
- Current, unrestricted Texas RN license or active Compact (NLC) nursing license required
- 3–5 years of nursing experience in a direct patient care setting, plus 1–2 years in a health plan or managed care organization, preferably with a commercial population
- Working knowledge of health plan benefits, CPT/ICD-10 codes, authorizations, and pre-certification processes
- Bilingual English/Spanish fluency required
- Bachelor of Science in Nursing (BSN) or higher
- Certified Case Manager (CCM) credential or American Case Management (ACM) certification
- Experience in telephonic care coordination, outreach nursing, or call center-based patient engagement
- Experience with HEDIS measures, care gap closure, or UM background (MCG/InterQual guidelines)
Required
Preferred
Telecommuting Requirements
- This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas. Candidates must reside in the Eastern or Central time zones.
- Company business hours are weekdays 9-5 CST.
- 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.