Clinical Care Specialist

About Employer Direct Healthcare

Employer Direct Healthcare is focused on giving access to quality & affordable healthcare for our members. We understand and have experienced the challenges of navigating specialized healthcare and we are dedicated to making a change.

We partner with large self-funded employers to create a benefit program for specialized care. We connect with high-quality providers to give our members peace of mind when going into surgery. And we support our members by helping them navigate the tricky aspects of healthcare; whether that be selecting a doctor, scheduling appointments, or following up after a procedure has been completed to make sure our members are feeling better.

About You:

• You have a drive and AMBITION to tackle big problems. Big problems require big ideas and a team that supports new ideas.
• You CARE deeply for your customers. Your customers aren’t just the individuals using your product. They are the driving factor in your motivation to make a change.
• You thrive in a TEAM ENVIRONMENT. Collaboration is key in innovation and creating change.
• A DIVERSE environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with.
• You are DETAIL ORIENTED, but more so, focus on the execution of your content while balancing a fast-paced environment.
• You understand that PROGRESS is critical to making change. You take the time to celebrate the small and big wins. Understanding that each improvement to a process helps move towards a greater change.
• INTEGRITY guides you in life. Focusing on the truth versus just giving people the answers they want to hear.

If this sounds like you, we would love to connect to speak further about career opportunities at Employer Direct Healthcare.

Please apply to our role & someone from our HR Team will reach out to help you navigate our interview process.

Clinical Care Specialist

The goal of enhanced clinical care navigation is to better engage patients directly to support their selection of top-quality providers available through SurgeryPlus. Through this effort, the Clinical Care Specialist will drive improved patient experience and stronger utilization of our services.

Professional RN or PA with orthopedic surgery (General & Spine) and bariatrics clinical experience, who will join a clinical team offering individualized assistance to patients as they navigate their surgery journey. The Clinical Care Specialist will help the patient understand the SurgeryPlus program and guide them in determining which SurgeryPlus surgeon is the appropriate choice given their needs and preferences. The scope of this position includes provider selection, consult, and procedure touchpoints with members based on their clinical needs. This role provides education and resources to facilitate and support informed decision making for the patient. The appropriate candidate will have the skills and knowledge to answer questions from patients as they consider which surgeon is right for them, leveraging various resources of data (from quality review materials to network contracting information) to better inform the patient of their surgeon options. Ideally this is a Nurse or Physician Assistant preferably with office-based surgical experience, with demonstrated ability to communicate effectively with both patients and providers.

Location: Hybrid (Dallas, TX) or Remote

Responsibilities and Duties

• Increase the number of patients selecting an EDH recommended provider for their surgery by:
• Educating the patient on the SurgeryPlus program, the importance of certification and quality, and how to assess a surgeon
• Articulating the quality of the specific providers recommended to the patient
• Answering questions/addressing concerns related to our providers
• Single point of contact for the clinical related questions based on patient needs
• Ensure appropriateness of provider recommendations by:
• Thoroughly understanding the EDH network of providers
• Reviewing patient information to better inform appropriateness of provider selected to meet their unique needs
• Comparing of those recommendations to existing surgeons where applicable
• Understanding and appropriately communicating nuances around contracted facilities (e.g., direction if a hospital is needed)

Duties and Expectations:

• Managing high volume inbound and outbound calls, engaging and enabling patients to use our benefit through a more tailored provider recommendation discussion centered around quality
• Providing education and support to the patient and families
• Educating patients on provider choices and in turn providing a comprehensive understanding of the surgery and our provider network
• Meeting and exceeding metrics of success as outlined by management
• Documenting feedback and opportunities to increase conversion rate
• Collaborating with the Member Services and Network teams to understand the various nuances that should be highlighted to the patient
• Contributing to and collaborating with Member Services and Network team members to positively impact patient outcomes and patient experiences.
• Establishing progress and gathers feedback:
• Manages surveys regarding patient satisfaction with the services received, services provided, and the impact of patient education, programs, and counseling.
• Prepare and deliver progress reports detailing programmatic activities for the department as required.
• Functioning in an organized and time conscious manner