Remote Care Navigation Nurse | Advocate & Care Coordinator

5G Benefits & Insurance; Fond du Lac (WI); Remote; USD 55,000 - 65,000; Full time

Benefits offered by this job

STD/LTD/AD&D insurance

Life insurance $50k

Paid holidays

Generous PTO

Remote-friendly scheduling

Job summary

InterceptCare is seeking an experienced RN/LPN to advocate for employees and their families, guiding them through complex health plans and care options. You will partner with employers, providers, and PBMs to remove barriers and ensure members receive appropriate care at the right place and cost.

The role emphasizes personalized, high-touch support, education on plan benefits, and coordination of services across imaging, specialists, and medications. Remote-friendly schedule available.

Qualifications

• Active RN or LPN license required.
• Clinical nursing experience required; experience in care coordination, utilization management, population health, or healthcare navigation preferred.
• Strong understanding of healthcare terminology, procedures, medications, and common treatment pathways.
• Experience with health insurance, self-funded plans, TPAs, provider networks, prior authorizations, or claims preferred.
• Strong communication, critical-thinking, problem-solving, and organizational skills.
• Ability to communicate complex healthcare and benefit information understandably.
• Comfortable advocating for members with physicians, facilities, insurers, employers, and vendors.
• Ability to manage multiple member cases and priorities independently.
• Strong attention to detail and follow-through.
• Ability to handle confidential protected health information.

Responsibilities

• Serve as a primary point of contact for members needing help navigating healthcare services.
• Educate members to understand healthcare options based on quality, cost, convenience, and preferences.
• Provide individualized support for complex cases and new diagnoses.
• Advocate for members when barriers delay or prevent care.
• Coordinate referrals to preferred and direct-contracted providers as appropriate.
• Assist with scheduling imaging, procedures, specialty appointments, and DME.
• Coordinate transfer of orders and records between providers when needed.
• Collaborate with providers to resolve referrals, scheduling, prior authorizations, and benefits issues.
• Identify opportunities to redirect care to high-quality, lower-cost providers.
• Educate members on cost differences and respect their choices.
• Identify savings opportunities related to imaging, procedures, medications, DME and other high-cost services.
• Assist with medication savings opportunities, including preferred pharmacies and biosimilars.
• Develop and maintain relationships with providers, TPAs, PBMs, DME vendors, and direct-contract partners.
• Educate provider offices on InterceptCare referral and billing processes as needed.
• Troubleshoot eligibility, billing, claims, contracting, and prior authorizations issues.
• Provide education to employer groups and employees about InterceptCare services.
• Participate in employee benefit meetings, open enrollment events, and onsite education sessions.
• Develop strong relationships with HR and employer leadership while maintaining confidentiality.
• Maintain accurate documentation of member interactions, referrals, and outcomes.
• Assist with reporting on utilization, outcomes, and program effectiveness.
• Identify trends and opportunities to improve member experience.

Skills

RN or LPN license

Clinical nursing experience

Care coordination

Healthcare navigation

Communication skills

Organizational skills

Problem-solving

Confidentiality

Job description

InterceptCare is seeking an experienced RN/LPN to advocate for employees and their families, guiding them through complex health plans and care options. You will partner with employers, providers, and PBMs to remove barriers and ensure members receive appropriate care at the right place and cost.

The role emphasizes personalized, high-touch support, education on plan benefits, and coordination of services across imaging, specialists, and medications. Remote-friendly schedule available.