Clinical Care Specialist
Core
Registered nurse who proactively engages surgical benefit members and guides them to high-quality providers within Centers of Excellence (COE) for spine, orthopedics, gynecology, bariatric surgery, and more.
Role type
Senior IC clinical care specialist (RN)
Builds
Member engagement and provider selection for surgical care journeys
Domain
Healthcare / Specialty Surgery
Deliverable
client delivery
Required skills
Registered Nurse license (TX/NY), Med-surg background, Clinical expertise in spine/ortho/GYN/bariatric, Patient navigation, CRM documentation, Medical terminology, HIPAA compliance
Preferred skills
BSN, UR or case management experience, Bilingual (English/Spanish), Nurse navigation
Technologies
Microsoft Office, CRM systems
Responsibilities
Conduct proactive outreach to introduce surgical benefits, Guide members to appropriate COE providers, Answer clinical questions regarding surgical processes, Review member information for clinical appropriateness, Educate members on surgical preparation and recovery, Serve as clinical resource for internal teams, Collaborate with leadership on complex cases
Seniority
Mid-level, hands-on IC