Registered Nurse, Care Manager - Apree Health

apree Health, the combined entity of Castlight and Vera Whole Health, is seeking skilled RN Care Guides to join our outstanding clinical support team. apree health is building the first integrated health network that combines data-driven personalization, a coordinated care model, and aligned incentives to unlock value and make life better for those we serve. You will play a vital role in condition management services, with a focus on Complex Case Management. These shared services include RN triage, care gap closure, disease education, care planning, care coordination, discharge planning, patient outreach, medication education and management, ED impact and diversion, discharge management, as well as addressing barriers to care when necessary. Join us in making a positive impact on healthcare delivery and outcomes.

● Ability to understand impact of high and rising risk populations on the total cost of care
● Utilize systems and tools provided to identify individuals in need of gap closure, care
coordination, and follow-up activities
● Address overutilization of ED services and provide level of care steerage and education
● Assess and participate in care team meetings (when applicable) to ensure appropriate
clinical care, support programs, coaching and case management programs are being
utilized
● Participate in wellness outreach and services to encourage preventive health screenings and health maintenance (may include monitoring biometrics)
● Provide education related to disease states, treatment options, lifestyle modifications,
and health literacy when needed, ensuring the patient has necessary knowledge and
support to be successful with plan of care
● Collaborate with Care Guides to assist patients with benefits education, referrals, billing & claims, eligibility and digital platform concerns
● Provide RN Triage per established guidelines
● Compliance with all confidentiality protocols and applicable laws
● Document accurately and thoroughly, adhering to all good documentation practices
● Must be eager to receive and apply routine feedback for continuous improvement as a
result of call and case documentation reviews
● Receive escalations for medically complex needs and questions
● Other duties as assigned

● Minimum 4-5 years of relevant clinical experience
● BSN or MSN preferred
● Unencumbered registered nursing license with at least a compact license with intent to complete state licensure in 50 states plus the District of Columbia 

● Experience in a multi-channel healthcare support environment a plus
● Experience in case management, care management or clinical coordination a plus

● Multiple system experience including EMR, Salesforce and Google suite
● Willing to provide a list of required information for our credentialing process
● Knowledge of insurance standards and the payer/provider relationship including referral
management, prior authorizations and medical necessity documentation
● Familiarity with HEDIS and STAR quality measures and gap closures preferred

 

● Requires being at a desk for extended periods of time