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Role Description

We are seeking an experienced Care Navigation RN to provide direct, patient-centered support to our members. In this role, you will be the primary point of contact for members navigating complex health journeys. You will utilize your clinical expertise to improve health outcomes, reduce barriers to care, reduce costs, and provide compassionate advocacy within a high-performance, virtual environment.

• Deliver coordinated, patient-centered virtual Care Navigation by telephone and digital channels to improve member health outcomes and satisfaction.
• Lead proactive outreach efforts to identify high-risk individuals; complete comprehensive clinical assessments and develop tailored care plans for enrolled members.
• Utilize the Nursing Process and a holistic "whole person" approach—including pharmacy interventions, crisis support, and disease-specific education—to support members.
• Assist members in navigating the complexities of the healthcare system, providing education and empowerment to help them meet their healthcare goals.
• Provide longitudinal Care Navigation during acute episodes, such as hospitalizations and rehabilitation stays, supporting both the member and their family through the transition of care.
• Identify clinical or social barriers to health and provide targeted interventions, connecting members to relevant health benefit resources and social determinants of health (SDOH) support.
• Work alongside other stakeholders and partners on co-managed cases and collaborate with internal teams to resolve complex benefit and claims questions.
• Build supportive, trusting relationships through passionate follow-up care and consistent advocacy.
• Maintain strict compliance with all regulatory, accreditation, and internal policy standards.
• Demonstrate an understanding of the functions of other departments, communicate with other departments appropriately and maintain positive working relationships.

Qualifications

• Active RN license in a compact state with the ability to obtain licensure in other states as needed.
• 2+ years of experience in case management for a health plan or TPA and 2+ years of experience in a hospital or clinical setting.
• Experience across multiple specialties, including med/surg, oncology, behavioral health, maternity, critical care/emergency, pediatrics, or community care.
• Strong competence in using multiple computer/medical record systems (EMRs), preferably Salesforce, and Google Workspace.
• Ability to talk, type, and navigate an electronic chart simultaneously in a remote setting.
• Proven ability to prioritize assignments, manage a busy caseload, and meet daily goals independently.
• Experience in telephonic care management with no direct/face-to-face patient contact.
• A drive for identifying and implementing clinical best practices.

Requirements

• Knowledge of Managed Care Programs.
• Knowledge or certification in Motivational Interviewing.
• Case Manager Certification.

Benefits

• Great overall employee experience with opportunities for career growth.
• Meaningful mission-driven work.
• Above average total rewards package.
• Salary range for this position is $71,400 - $118,000 annually.
• Numerous factors including education, skills, work experience, certifications, etc. will be considered when determining compensation.
• Alternative medicine coverage.
• Generous PTO.
• Up to 16 weeks paid parental leave.
• Paid holidays.
• 401k program.
• Transportation perks.
• Education reimbursement.
• Paid paw-ternity leave.