Care Team-Registered Nurse

About the role

This role is critical in supporting members through high-quality clinical case management and coordination of expert medical opinions. This position involves reviewing complex medical cases, ensuring clinical completeness, and facilitating the delivery of expert insights. This is done through collaboration with physicians and internal teams.

Responsibilities

• Managing assigned Care Team case workload from intake through completion. Ensuring cases meet established timelines, service level agreements (SLAs), and performance guarantees (PGs).
• Maintaining knowledge of workflows, clinical operations, and organizational policies and procedures.
• Demonstrating ownership of case progression and timely delivery of services.
• Evaluating medical records and imaging for completeness and clinical quality. Reviewing, interpreting, and synthesizing complex medical records.
• Creating clear, concise, and structured written case summaries. Identifying gaps in records and determine when additional information or testing is required.
• Triaging cases to the appropriate clinical specialty and consulting physician.
• Collaborating with physicians, summary coordinators, and healthcare navigation teams. Ensuring all clinical components are aligned for accurate expert delivery.
• Communicating effectively within the nursing team and cross-functional partners. Escalating issues, risks, or concerns to leadership as appropriate.
• Adhering to all confidentiality and HIPAA requirements in accordance with company policies. Ensuring compliance with all operational and clinical standards.
• Participating in quality improvement initiatives and organizational projects.

Requirements

• Possess BSN in Nursing required or currently in progress.
• Hold active RN license in good standing.
• Have experience managing relationships with external clients or partners.
• Have experience reviewing and analyzing complex patient medical records.
• Demonstrate good attention to detail, critical thinking, and problem-solving skills.
• Display excellent written and verbal communication abilities.
• Possess dynamic customer service orientation.
• Be proficient in Microsoft Outlook, Word, Excel, and Adobe PDF tools.
• Have ability to work independently and collaboratively in a team environment.
• Be comfortable in an urgent, evolving operational setting and flexible to changing priorities.
• Application and Interview
• Alight requires all virtual interviews to be conducted on video. Please be aware that Alight is a camera-on culture and may require occasional travel to one of our physical office locations.
• Our commitment to Inclusion
• We celebrate differences and believe in fostering an environment where everyone feels valued, respected, and supported. We know that diverse teams are stronger, more innovative, and more successful.
• At Alight, we welcome and embrace all ind

Benefits

Additional Information

Our story At Alight, we believe a company's success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to "Be Alight." We are passionate about connecting purpose with impact. Alight empowers clients to build a healthier and more financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, navigation, and absence management.

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