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Job Description Summary
Position Title: RN Care Guide
How will you make an impact & Requirements
Gap Closure & Care Coordination — Identify patients needing follow-up, care coordination, or intervention using provided systems and tools.
ED Overutilization Reduction — Provide education and steerage to appropriate levels of care.
Telephonic RN Triage — Use standardized protocols (e.g., Schmitt-Thompson) to guide patients to safe, appropriate care.
Proactive Outreach — Complete Health Risk Assessments, assess for safety concerns, and connect patients to clinical/community resources.
Caseload Management — Manage a high-volume panel and triage queue while maintaining clinical quality and compassion.
Care Team Collaboration — Participate in care team meetings to ensure coordinated, appropriate care.
Patient Education — Provide disease, medication, and lifestyle education to support patient success.
Empathy & Ownership — Deliver compassionate, patient-centered care with a focus on outcomes.
Confidentiality Compliance — Adhere to all confidentiality laws and protocols.
Cost of Care Awareness — Understand the impact of rising-risk populations on total cost of care.
Cross-Functional Collaboration — Work with Care Guides on benefits, referrals, billing, claims, and digital platform issues.
Wellness Outreach — Support preventive screenings and health maintenance initiatives.
Documentation — Complete timely, accurate documentation in the system of record.
Continuous Improvement — Apply feedback from call and documentation reviews.
Other duties as assigned.
4–5 years of relevant clinical experience
Experience in care management, RN triage, disease management, care coordination, or primary care preferred
BSN or MSN preferred
Unencumbered RN license with Compact Licensure required
Must provide all required credentialing documentation promptly (licenses, transcripts, immunizations)
CPR certification required
Bilingual in Spanish is a plus
Experience with Athena and NextGen is a plus
Familiarity with Schmitt-Thompson triage protocols
Experience with EHRs, Salesforce, and Google Suite
Knowledge of insurance standards, referral management, prior auths, and medical necessity
Familiarity with HEDIS and STAR measures preferred
Must maintain a HIPAA-compliant remote workspace with reliable internet and a backup plan
Extended periods of sitting, typing, and computer use
Occasional lifting up to 50 lbs
Normal corrected vision, hearing, and speech
Remote work environment meeting HIPAA standards
Compensation:
$35.43to
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