Job Description

ABOUT THE ROLE:

Under the general supervision of the Sr. Clinical Manager, the Case Manager RN performs clinical triage, high-risk outreach, condition support, care planning, clinical education, and care coordination functions in supporting Rightway members with navigating, accessing, and best supporting their care needs. The Case Manager RN also serves as a trusted advisor for providing clinical guidance and directing to the most appropriate high-quality care providers with the objective of improving clinical outcomes while also reducing healthcare costs e.g. minimizing ED or other unnecessary care visits while increasing utilization of more appropriate care settings, such as primary care doctors.

WHAT YOU'LL DO:

• Clinical triage to assess the severity of the member’s health concerns using evidence-based protocols and algorithms in directing care to the right healthcare resource in a timely manner without compromising quality or safety 
• Leveraging data-driven analytics in conducting proactive outreach to engage members of clinical interest, e.g. e high-risk, high-spend, rising risk, and evidence of care gaps with the objective of engaging and assisting members in making more informed care decisions, supporting across their continuum of care and well-being journey with lifestyle and behavior changes.
• Engage members in clinical conversations to best understand their care needs, assess risks, preferences, and care barriers, and then guide and recommend appropriate next steps to improve health outcomes
• Identify and address barriers preventing members from accessing preventative care or establishing ongoing relationships with primary care providers
• Assist in scheduling appointments, referrals, and follow-up care to close gaps in preventative care and chronic disease support
• Clinical navigation support includes but is not limited to personalized condition education, care options, and planning, care compliance, medication adherence, shared decision support, and care coordination
• Leverages appropriate input and direction from the Rightway clinical lead to determine the best clinical options for more complex member healthcare needs.  
• Accurately documents symptoms/complaints, nursing assessment, the guidance provided, and member/caller response. 
• Acts in the best interest of the member by being a health advocate and supporter in the member’s healthcare journey.
• Coordinates the completion of screening services for high-risk members by providing care support, adherence follow-up, and care coordination support.
• Member’s trusted healthcare advisor, member experience, and retention focus e.g. longitudinal care education, guidance, and support
• Develops effective collaboration and working relationships across the Navigation team and organization.
• Maintains a member-centric, customer-driven professional attitude.
• Stay within the RN scope of practice by strictly following our care navigation protocols unless directed to do otherwise by a provider on the clinical team and documenting appropriately when a change occurs.

 

WHO YOU ARE: 

• RN, ADN, or BSN degree 
• Must be fluent in Spanish
• Holds an active and in good standing RN license in a compact state
• 5+ years of direct patient care experience required, preferably in family medicine 
• Triage nursing experience desired 
• Population health, disease management, or similar experience required
• Care management or chronic condition support experience desired

 

HOURLY RATE:

$34.00-$40.86

 

ABOUT RIGHTWAY:

Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide members to the best care and medications by inserting clinicians and pharmacists into a member’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving members the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.

Since its founding in 2017, Rightway has raised over $130mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global at a valuation of $1 billion. We’re headquartered in New York City, with a satellite office in Denver. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.

HOW WE LIVE OUR VALUES TO OUR TEAMMATES:

We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members who will:

• We are human first

Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding. 

• We redefine what is possible 

We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.

• We debate then commit 

We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.

• We cultivate grit 

Changing healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.

• We seek to delight

Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success. 

Rightway is PROUDLY an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance.

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