Bilingual RN Care Coordinator, Spanish

This is a fully remote position, open to applicants in Texas.

📋 Description

• Engage in both proactive and reactive outreach to members based on risk stratification and care gap analysis.

• Utilize motivational interviewing techniques to respond to inquiries from members and providers.

• Perform thorough clinical, psychosocial, and social determinants of health (SDOH) assessments.

• Create personalized care plans, track progress, and coordinate resources throughout the care continuum.

• Inform members and providers about benefits, digital health solutions, and evidence-based self-management techniques.

• Act as a communication liaison between utilization management, providers, and members.

• Accurately document activities related to care coordination and utilization management support.

• Handle escalations to the appropriate clinical resources as needed.

• Encourage member participation in Evry Health’s digital health initiatives.

⛳️ Requirements

• A diploma from an accredited nursing school is mandatory; an Associate Degree in Nursing (ADN) or higher is preferred.

• A current, unrestricted Texas RN license or an active Compact (NLC) nursing license is required.

• 3 to 5 years of nursing experience in a direct patient care environment is essential.

• 1 to 2 years of experience in a health plan or managed care organization, ideally with a commercial population.

• Familiarity with health plan benefits, CPT/ICD-10 codes, authorization, and pre-certification processes is necessary.

• Bilingual proficiency in English and Spanish is required.

• A Bachelor of Science in Nursing (BSN) or higher is preferred.

• Certification as a Case Manager (CCM) or American Case Management (ACM) certification is preferred.

• Experience in telephonic care coordination, outreach nursing, or patient engagement in a call center setting is advantageous.

• Knowledge of HEDIS measures, care gap closure, or utilization management using MCG/InterQual guidelines is preferred.

• Candidates must reside in the Eastern or Central time zones.

• A dedicated workspace that is separate from other living areas and ensures information privacy is required.

• The ability to secure sensitive company documents is essential.

• Must live in an area with access to high-speed internet service.

🏝️ Benefits

• Fully remote work environment.

• Remote work opportunity available for the entire company.

• Standard business hours from 9 AM to 5 PM CST.

• Requirement for a dedicated workspace that supports privacy.

• Secure management of sensitive company documents.

• High-speed internet service provided at the residence.