Nurse Advocate (Bilingual)

Specialty Care Management • Chicago, IL

8d • $80,000 - $85,000 • Remote

About The Position

The Nurse Advocate provides care management and advocacy support to high acuity members participating in our renal care programs. This role is essential to the success of the RenalAdvocate product and financial outcomes for health plan clients, focusing on proactive member engagement, clinical risk monitoring, and care coordination to improve health outcomes for individuals living with chronic kidney disease and end-stage renal disease.
The Nurse Advocate must be native fluent bilingual in Spanish and will support members in all time zones throughout the United States. Some evening hours and weekend hours are required.

Requirements

• Native fluent bilingual in Spanish is required.
• A minimum of 3 years RN experience in a related role; kidney and ESRD clinical experience is required.
• Must have an active RN license that is in good standing and compact/multi-state.
• Ability to work some evening hours and weekend hours to accommodate members in multiple time zones is required.
• Ability and willingness to travel multiple times a year, which will include overnight stays for corporate gatherings, conferences, and health fairs.
• Ability to attend and professionally engage in video meetings with other employees and with members.
• Reliable internet and power with a designated area to conduct work without unnecessary interruptions.
• Strong technological skills, meaning you can effectively and efficiently use computers, peripheral equipment, and applications/systems, including Microsoft products.
• Autonomous self-starter who is comfortable with ambiguity and can navigate change.
• Creative mindset and ability to appropriately challenge the status quo.
• Superb written and oral communication skills.
• Ability to overcome obstacles with a ‘yes if...’ approach.
• Ability to effectively balance competing deadlines without losing focus on the bigger picture.

Nice To Haves

• Utilization review and/or Care Management experience highly preferred.
• Experience working remotely is highly preferred.

Responsibilities

• Effectively service and maintain an assigned caseload of up to 125 high acuity managed members, which includes development and maintenance of rapport with managed members through telephonic or video coaching as well as a pulse on their health status and disease progression indicators through initial and ongoing assessments.
• Outreach to providers to obtain pertinent member treatment/health record information and assist with coordination of Care.
• Complete member education calls to support the long-term success of members engaged in the RenalAdvocate program, including establishment of personal and clinical goals and education on key topics related to disease progression
• Provide support to members with barriers related to social determinants of health.
• Request/receive member PHI and ensure all information is appropriately documented/shared. Clinical and administrative information should always be documented in the appropriate clinical system in real time while communicating with the member. Nurses are responsible for accurate and timely documentation. .
• Adhere to workflows and processes that support meeting reporting requirements, NCQA guidelines as well as align with established care paths and intervention protocols for optimal clinical and financial outcomes
• Provide short-term advocacy and navigation to members that are not participating in a clinical program (risk pool) in order to support the operations of the Dialysis (Cost Containment) team.
• Identify and share potential methods of increasing member engagement.
• Support team KPIs and corresponding individual metrics relating to areas outlined below: Unplanned start to dialysis Lab Adherence Member Engagement/Coaching Rate Controllable Churn
• Manage escalations that require client intervention and deliver to Sr. Director of Member Advocacy in real time.
• Assist Client Service Managers with the collection of member success stories, cost savings, program outcomes, successful referrals, and successful closed care gaps.
• Assess members at risk utilizing claims data and clinical expertise, document findings, and make appropriate notifications to internal and external stakeholders promptly.
• Notify Integrated Care Nurse and Sr. Director of Member Advocacy of members with significant risk that could result in high-cost claims.
• Maintain an appreciation of how your individual work and member management contributes to client facing performance outcomes.
• Bring empathy, education and enthusiasm to member interactions for continual demonstration of the value of the Renalogic service
• Courageously adapt, celebrate the achievements of others, and take pride in doing quality work.
• Develop and leverage self-awareness and self-management to establish and maintain genuine relationships with colleagues, leadership, and other internal teams.
• Proactively learn about and consciously leverage your strengths in a manner that supports cohesion and company wide success.

Benefits

• Market competitive salary and, including potential annual merit increases and bonuses contingent on the company’s fiscal performance.
• Generous paid time off and paid holidays, because we appreciate recharging.
• A comprehensive health benefits plan with a portion of premiums covered by the company. Benefits include medical, dental, vision, and other benefits which are optional to the employee. Eligibility begins the first of the month following 60 days of employment.
• 401k with up to 4% employer match. Eligibility begins the first of the month following 6 months of employment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed