About Evry Health and Globe LifeEvry Health is 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.About the roleEvry Health is seeking a tech-savvy and bilingual (English/Spanish) 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. Our teams are 100% virtual.Roles and ResponsibilitiesCommunicate 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 handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement.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 manage 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.Interact with external facilities or providers as needed to gather clinical information to support the medical necessity review process and plan of care.Experience and Skills Desired1-2 years of experience working at a health plan, preferably with a commercial population.3-5 years of nursing experience in a clinical setting assisting with direct patient care, such as a hospital or ambulatory setting.Spanish fluency (conversational).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.Working knowledge of medical and insurance industry terminology including basic understanding of health plan benefits, CPT/ICD10, authorizations, and digital health programs.Area of interest or experience within cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology.Experience outreaching and educating members telephonically.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.Telecommuting RequirementsThis is a remote position; the whole company works remotely.Company headquarters are in Dallas, Texas.Company business hours are weekdays 9-5 CST. Candidates must reside in the United States and in the Eastern or Central time zone.Work during stated business hours as well as rotating on-call weekends.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.Benefits PackageCompetitive salaryComprehensive health, dental, and vision insurance as well as life and disabilityRetirement savings plan with company matchGenerous time off/vacationProfessional development opportunitiesFlexible and remote work environment
