Nurse Advocate; Bilingual

Overview

Type: Full-time, salaried, FLSA exempt

Pay: $80,000 - $85,000 annually, plus bonus potential

Location: US, remote; some evening hours, weekend hours, and travel are required

Who We Are Renalogic is dedicated to helping our clients manage the human and financial costs of chronic kidney disease. To help us in our mission, we hire people who are humble, hungry, and smart. And it sure helps if you have a sense of humor. We re not perfect, but we re trying to build a company that we are all proud of.

Our 96% client retention suggests we re on the right path.

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 Impact Advocate 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 You ll 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 Impact Advocate 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…