Personal Health Advocate

• Educate members on their medical conditions, diagnostic testing, test results, and available treatment options
• Explain complex medical and benefit-related information clearly and compassionately
• Build trusted relationships that empower members to actively participate in their healthcare decisions

🔹 Care Coordination & System Navigation

• Provide members with options for healthcare providers and services based on clinical needs, geographic location, and benefit coverage
• Research providers through credentialing, education verification, and affiliations with recognized medical centers
• Facilitate communication between members, treating physicians, and insurance carriers
• Assist with scheduling and re-scheduling appointments, transferring medical records, resolving access issues, and clarifying benefit provisions
• Intercede on behalf of members to obtain earlier appointments or remove barriers to care
• Support members with prescriptions, pre-service fee negotiations, and authorization-related challenges

🔹 Case Management, Documentation & Follow-Up

• Maintain accurate, timely documentation using approved case management systems and procedures
• Place outbound follow-up calls when issues cannot be resolved during the initial interaction
• Respond to delegate box, answer service, and after-hours calls as required
• Escalate cases appropriately and on a timely basis to supervisors or internal clinical resources

🔹 Professional Growth & Team Contribution

• Stay current on patient care procedures, diagnoses, authorizations, denials, and evolving healthcare practices
• Mentor and support new team members as needed
• Collaborate with colleagues to maintain service excellence and balanced workflows
• BSN or RN degree from an accredited college or university (required)

Licensure

You are an experienced nurse who brings clinical judgment, composure, and accountability to every interaction.

You naturally demonstrate:

Ownership and follow-through

• You take responsibility for member outcomes and see cases through with care and precision.

Empathy grounded in professionalism

• You listen deeply and respond with compassion while maintaining clarity, confidence, and appropriate boundaries.

Strong critical thinking

• You quickly synthesize clinical information, prioritize what matters, and determine effective next steps.

Clear and confident communication

• You explain complex medical and insurance concepts in a way members can understand and trust.

A commitment to quality and results

• You are motivated by accuracy, meaningful resolution, and delivering an exceptional member experience.

Curiosity and continuous learning

• You stay current on healthcare trends, systems, and procedures to provide thoughtful, informed guidance.

Who Will Thrive in This Role

You will thrive in this role if you are comfortable balancing compassionate member conversations with a fast-paced, high-volume phone environment. This is a strong fit for someone who can stay organized, document thoroughly and in real time, follow cases through to resolution, and maintain a calm, professional presence while managing multiple member needs throughout the day.

This position is fully remote and requires a dedicated, HIPAA-compliant workspace with reliable internet access.

The nature of the work is sedentary, involving prolonged sitting and continuous computer and phone use. Essential functions include repetitive motion, typing, concentration, reading, and ongoing verbal and written communication throughout the workday.

• Strong organizational and administrative abilities
• You’ll join an organization that values structure
• and compassion — where your clinical judgment directly improves the lives of the members you serve.