The RN Care Coordinator delivers comprehensive, member-centered care coordination and develops individualized care plans for a commercial health plan population. They also facilitate member engagement, provide education on benefits and digital health solutions, and support utilization review processes.
Role Summary
The RN Integrated Care Coordinator is a core clinical contributor delivering comprehensive, member-centered care coordination across the care continuum for Evry Health's fully insured commercial health plan population. The role combines proactive and reactive member engagement, and individualized care planning in a fully remote, technology-forward environment.
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Roles and Responsibilities
Proactive & Reactive Member Engagement: Conducts outreach based on risk stratification and care gap data, and responds to member/provider contacts, using motivational interviewing to build trust and drive benefit and program engagement.
Care Plan Development & Coordination: Conducts comprehensive clinical, psychosocial, and SDOH assessments and develops individualized care plans, monitoring progress and coordinating resources across the care continuum.
Member & Provider Education: Educates members and providers on benefits, digital health solutions, and evidence-based self-management strategies, translating complex information into clear, actionable guidance.
Utilization Review Support: Serving as the communication bridge between the UM team, providers, and members to ensure members get the right care at the right place of service.
Documentation, Escalation Management & Digital Health Promotion: Accurately documents all care coordination and UM support activity, manages escalations to appropriate clinical resources, and promotes member enrollment in Evry Health's digital health programs.
Qualifications
Required
Diploma from an accredited school of nursing required; ADN or higher preferred
Current, unrestricted Texas RN license or active Compact (NLC) nursing license required
3–5 years of nursing experience in a direct patient care setting, plus 1–2 years in a health plan or managed care organization, preferably with a commercial population
Working knowledge of health plan benefits, CPT/ICD-10 codes, authorizations, and pre-certification processes
Bilingual English/Spanish fluency required
Preferred
Bachelor of Science in Nursing (BSN) or higher
Certified Case Manager (CCM) credential or American Case Management (ACM) certification
Experience in telephonic care coordination, outreach nursing, or call center-based patient engagement
Experience with HEDIS measures, care gap closure, or UM background (MCG/InterQual guidelines)
Telecommuting Requirements
This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas. Candidates must reside in the Eastern or Central time zones.
Company business hours are weekdays 9-5 CST.
Required to have a 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.
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Marketing Manager
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