Bilingual Care Coordination (RN)

1-2 years of experience working at a health plan. 3-5 years of nursing experience in a clinical setting (hospital or ambulatory). Spanish fluency (conversational). Current, unrestricted Texas nursing license or Compact License. Diploma from an accredited school/college of nursing. Working knowledge of medical and insurance industry terminology. Understanding of health plan benefits, CPT/ICD10, authorizations, and digital health programs. Experience or interest in cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology. Experience outreaching and educating members telephonically. Familiarity with Salesforce/Healthcloud/CareIQ (Bonus). Experience working in a call center (Bonus).

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. Provide pro-active and reactive support for members through outreach. Employ active listening and motivational interviewing skills, handle difficult calls tactfully, and document accordingly. Effectively excel in a virtual work environment through active participation in team meetings and efficient call documentation. Accurately track and document work on internal software tools. Consult with supervisors and medical directors to overcome barriers. Manage escalations within the department. Assist departmental staff with coding, medical records, pre-certification, reimbursement, and claim denials/appeals. Interact with external facilities or providers to gather clinical information.