Summary of Position
The Nurse, Care Coordinator provides proactive utilization management services for Teladoc Health members with high-risk needs, inappropriate utilization of urgent or emergent care and/or complex medication needs. This role delivers excellent customer service and facilitates conversations between interdisciplinary care teams, which may include internal and external health care providers, such as Patient Navigators, Care Coordinators, Case Managers, Primary Care Physicians/Specialty Physicians and Hospital Systems. The Nurse Care Coordinator focuses on providing high quality, cost effective, care coordination.
Essential Duties and Responsibilities
- Deliver exceptional service to members, providers, care team members and external facilities representing Teladoc Health in a professional and courteous manner through a variety of communication channels including written, telephone, and video. (50%)
- Review members' cases with external health plan risk team and provide advice, direction, and support as needed.
- Meet with members and patient navigators after primary care physician appointments to review and update plans of care.
- Establish and retain patient documentation in external referral/care coordination systems.
- Process referrals and prior authorizations in a timely, thorough manner for members.
- Manage daily assignment to meet department-specific performance metrics by applying clinical knowledge to support members with care navigation needs (post-visit or post-hospitalization) which may include: (50%)
- Conduct intake assessment, coordinate treatment plan, and conduct re-assessment of services to ensure coordinated, high-value, in-network care to optimize health outcomes.
- Determine members' eligibility for and refer members to support services (such as health plan case management, external and internal referrals).
- Evaluate and interpret clinical data to identify high-risk members and to implement action-oriented member goals.
- Analyze complex clinical situations and appropriately provide solutions.
- Medication reconciliation.
The time spent on each responsibility reflects an estimate and is subject to change dependent on business needs.
Supervisory Responsibilities
No
Qualifications Expected for Position
- Certified Case Manager preferred.
- Prior care coordination experience preferred.
- Virtual work experience preferred.
- Ability to work independently and as part of a high performing team.
- Ability to receive work instruction and maintain department productivity standards.
- Exceptional customer service skills.
- Strong data analysis and clinical assessment skills.
- Excellent written and verbal communications skills.
- Strong time management and organizational skills, with ability to effectively manage multiple, competing priorities.
- Possess a high degree of computer literacy and ability to manage multiple systems, including Microsoft software.
- Ability to learn new procedures and adapt to changes in fast-paced working environment.
- Bilingual (English/Spanish) a plus.
The above qualifications, knowledge, experience, and/or background are expected but not required for this role.
Required license or credential needed to perform job
- Active RN, BSN or MSN, NP in good standing.
- 1-3 years of clinical experience.
- Customer service experience in a health care setting.
Work Environment: REMOTE
The base salary range for this position is $80,000-88,000K.