Nurse Advocate (Bilingual)

Type: Full-time salaried FLSA exempt
Pay: $80000 - $85000 annually plus bonus potential
Location: US remote; some evening hours weekend hours and travel are required

About Us

Specialty Care Management (SCM)is a purpose-driven healthcare organization focused on solving one of the most complex and costly challenges in the United States health system: chronic kidney disease and renal dialysis.

With an estimated 1 in 7 adults living with CKD and many progressing to dialysis without early identification or support SCM partners with health plans to proactively manage renal risk and protect members before claims become catastrophic.

For members who are already on dialysis SCM provides dedicated renal nurse coaches clinical advocacy access coordination and comprehensive support to help improve outcomes reduce complications and avoid unnecessary costs.

Through our platform of predictive analytics clinical programming specialized claims underwriting and strategic member engagement SCM transforms unpredictable high-cost dialysis exposure into a sustainable and member-friendly solution.

Position Overview

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.

How Youll Contribute

Member Support and Engagement

• 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

Client Support

• 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.

Behavioral Expectations

• 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.

What Youll Need

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

What We Offer

• Market competitive salary and including potential annual merit increases and bonuses contingent on the companys 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.

We are proud to be an equal opportunity employer which means that our employment decisions are inclusive and welcoming regardless of race gender age color sexual orientation gender identity pregnancy status religion national origin disability or any other personal physical mental or sensory traits. All individuals who are offered a position must successfully pass a background and reference check prior to their start. All individuals must demonstrate they are legally authorized to work in the United States without sponsorship.