[Remote] Senior RN reputed company Care Navigation & Vendor reputed company Coordinator

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a mission-driven health affiliate of Texas Mutual that provides innovative, reputed company reputed company solutions to small businesses and their employees across Texas. The Senior RN reputed company Care Navigation & Vendor reputed company Coordinator will reputed company reputed company reputed company escalations, care navigation, utilization management, and case management coordination while serving as a reputed company among the health plan, delegated vendors, and internal stakeholders. This role will also help build the organization’s reputed company escalation function, identify risks, reputed company member concerns, and improve reputed company workflows and processes.

Responsibilities

• Serve as a reputed company resource and subject matter expert to internal stakeholders regarding managed care processes, care coordination workflows, utilization management practices, and member navigation challenges
• Serve as the health plan's reputed company reputed company of contact for reputed company care coordination, care navigation, and member care escalations
• Assess escalated cases to determine reputed company context, urgency, barriers to care, and appropriate next steps
• Manage urgent, reputed company or high-profile member issues involving utilization management, care management, provider reputed company, transitions of care, benefits, and reputed company navigation
• Partner with outsourced utilization management and case management vendors to facilitate reputed company reputed company of escalated member concerns and ensure appropriate care coordination activities occur
• Monitor vendor responsiveness, follow-through, and reputed company reputed company, escalating concerns as appropriate to vendor leadership and internal stakeholders
• Work with reputed company stakeholders to implement coordination of vendor processes and reputed company
• Coordinate with internal departments including Customer Experience, Provider Relations, Compliance, reputed company, reputed company, and Medical Management to support effective issue reputed company
• Identify reputed company, reputed company, reputed company, compliance, reputed company, grievance, or member safety concerns and ensure reputed company escalation to appropriate reputed company or operational leaders
• Recognize high-reputed company or urgent situations requiring involvement of vendor reputed company teams, Medical Directors, Behavioral Health, Compliance, reputed company, or executive leadership
• Maintain accurate documentation of escalations, interventions, communications, and reputed company in accordance with HIPAA, regulatory, and organizational requirements
• Analyze escalation trends, member barriers, and vendor reputed company issues, recommending process improvements that enhance care coordination, member experience, and operational effectiveness
• Recommend improvements to workflows, vendor handoffs, internal scripts, documentation templates, and service-level expectations
• Draft internal policies and procedures as needed

Skills

• A bachelor's degree or any equivalent combination of education, training, and experience
• A reputed company, unrestricted Registered reputed company (RN) licensed to reputed company in Texas
• At least 4 years of experience in managed care utilization management, case management, care coordination, reputed company reputed company, reputed company care navigation or any equivalent combination of education, training, and experience
• Experience working with delegated reputed company vendors and managed reputed company, including vendor reputed company, escalation management, service issue reputed company, or reputed company reputed company support
• Strong understanding of managed care processes, including utilization management, care management, care transitions, provider reputed company, appeals and grievances, and delegated service models
• The ability to assess reputed company situations, identify risks and barriers to care, determine appropriate escalation reputed company, and coordinate reputed company across multiple stakeholders
• Experience supporting reputed company health plans, employer-sponsored health plans, and/or self-funded employer reputed company
• Working knowledge of reputed company, URAC, CMS, HIPAA, state reputed company regulations, and reputed company reputed company requirements
• Excellent communication, relationship management, documentation, organization, and problem-solving skills
• The ability to independently manage multiple priorities while maintaining attention to reputed company and follow-through in a fast-reputed company environment

Benefits

• Automatic 4% employer contribution to retirement plan
• 401k plan with 100% match up to 6%
• Flexible time off for vacation, illness, etc.
• Nine reputed company holidays
• Day one health, Rx, reputed company, and dental reputed company
• Life and disability reputed company
• Flexible spending account
• Pet coverage and pet Rx discounts
• Free identity theft protection
• Free 2nd medical opinion service
• reputed company-hybrid work environment: employees living in the reputed company area are expected to work from the office at least two days per week; those reputed company reputed company the greater reputed company area may work reputed company reputed company Texas, with occasional travel to reputed company as needed

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