RN Care Coordinator (Contractor)

About this role 

The role of the RN Care Coordinator (Contractor) is to work with members to introduce, coordinate, and guide members through their Transcarent experience . In this caseload carrying role, you will have an opportunity to improve members’ lives.  

Responsibilities include answering the phone, educating members on their benefits; uploading documents into the computer system; coordinating members surgical care with providers, obtaining precertification authorizations, requesting and reviewing medical records, working in collaboration with internal and external customers to ensure a flawless experience for our members. The RN Care Coordinator may interface with travel coordinators and clinical contacts provider locations. 

What you’ll do 

• Provide clinical subject matter expertise and guidance relating to individual cases and in broader strategy and processes 
  Communicate and follow-up with plan members to ensure understanding of programs while delivering high-quality customer service 
• Answer the phones and responds to incoming inquiries while utilizing care center training tools  
• Facilitate patients successfully through the surgery review process, exceeding expectations while meeting the program metrics  
• Efficiently and effectively manages a case load across a variety of clients and surgical categories 
• Coordinate the scheduling and approval process from the initial request for surgery to patient placement  
• Effectively address and resolve Member barriers to utilizing the benefit including addressing program questions and collecting medical records in a timely and accurate manner to ensure an expedited process
• Obtain the necessary information – demographic, financial, clinical and other pertinent data to complete referral process  
• Maintain and update application with current data, pertinent information, and status of cases
• Collaborate with providers, clinics and facilities, and various levels of management to effectively resolve issues. Obtain pre-authorizations
• Effectively address and resolve patient barriers to utilize the benefit including working with members to address program questions
• Develop new or update existing quality measures, protocols, processes, and policies to minimize risk and ensure compliance
• Provide information to COE facility and provider partners in support of achieving the highest quality experience for our Members
• Provide guidance relating to COE facilities and providers for targeting and participation
• Maintain confidentiality and knowledge of HIPAA regulations 

What we’re looking for 

• Registered Nurse with active, multistate licensure required; Bachelor of Science in Nursing (BSN) required.
• A minimum of 5 years clinical acute care experience as a practicing RN preferred.
• Experience in surgery preferred.
• Proficient in data entry, Microsoft Office, and contact center-style phone systems  
• Excellent customer service, written and verbal communication and interpersonal skills  
• A “delight the customer” attitude
• Strong organizational, critical thinking and problem-solving skills
• Strong attention to detail and follow-through
• Project management-type skills; prior experience managing a high-volume caseload
• An ability to focus in a high energy atmosphere
• Openness and understanding that dynamic environments include change, and welcoming that change with a positive attitude 

Nice to have 

• Flexibility - Openness and understanding that dynamic environments include change, and welcoming that change with a positive attitude.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information. 

As a remote, contract position, the hourly range for this role is:

$37.00 - $43.00/hr