Care Coordination - RN

TL;DR

Care Coordination - RN (Health Insurance): Communicate with members and providers to educate on benefits and digital health solutions, using negotiation and motivational interviewing to boost engagement. Focus on proactive outreach via phone/email/text, handling escalations, and documenting interactions to support care plans and medical necessity reviews.

Location: Remote (must reside in the United States and in the Eastern or Central time zone; business hours 9-5 CST with rotating on-call weekends)

Company

High-technology health plans division of Globe Life (NYSE:GL) on a mission to humanize health insurance with expanded benefits and personalized care.

What you will do

• Communicate and educate members/providers on insurance benefits and digital health solutions.
• Apply negotiation, motivational interviewing, and active listening to increase engagement and handle difficult calls.
• Provide proactive/reactive support via outbound phone/email/text outreach.
• Track and document work accurately in internal software tools.
• Consult with supervisors, utilization management, and medical directors to overcome barriers.
• Manage escalations with urgency and assist with coding, records, pre-certification, and appeals.
• Interact with external providers to gather clinical information for care reviews.

Requirements

• Current, unrestricted Texas nursing license or Compact License (include license number and state in resume)
• 1-2 years experience at a health plan, preferably commercial population.
• 3-5 years nursing experience in clinical settings like hospital or ambulatory care.
• Diploma from accredited nursing school.
• Working knowledge of medical/insurance terminology, health plan benefits, CPT/ICD10, authorizations.
• Reside in US, Eastern or Central time zone; dedicated private workspace with high-speed internet

Nice to have

• Experience in cardiology/pulmonology, women’s health, orthopedics, primary care/pediatrics, oncology.
• Telephonic outreach and education experience.
• Familiarity with Salesforce/Healthcloud/CareIQ.
• Call center experience.
• Conversational Spanish fluency.

Culture & Benefits

• 100% virtual teams in a flexible remote work environment.
• Comprehensive health, dental, vision, life, and disability insurance.
• Retirement savings with company match.
• Generous time off/vacation.
• Professional development opportunities.