Nurse Advocate

Type: Full-time, salaried, FLSA exempt
Pay: $80,000 - $85,000 annually, plus bonus potential
Location: US, remote; some evening hours, weekend hours, and travel are required

Specialty Care Management (SCM) is a purpose-driven healthcare organization focused on solving one of the most complex and costly challenges in the United States health system: chronic kidney disease and renal dialysis.

With an estimated 1 in 7 adults living with CKD, and many progressing to dialysis without early identification or support, SCM partners with health plans to proactively manage renal risk and protect members before claims become catastrophic.

For members who are already on dialysis, SCM provides dedicated renal nurse coaches, clinical advocacy, access coordination, and comprehensive support to help improve outcomes, reduce complications, and avoid unnecessary costs.

Through our platform of predictive analytics, clinical programming, specialized claims underwriting, and strategic member engagement, SCM transforms unpredictable, high-cost dialysis exposure into a sustainable and member-friendly solution.

The Nurse Advocate provides care management and advocacy support to high acuity members participating in our renal care programs. This role is essential to the success of the Renal Advocate product and financial outcomes for health plan clients, focusing on proactive member engagement, clinical risk monitoring, and care coordination to improve health outcomes for individuals living with chronic kidney disease and end-stage renal disease.

The Nurse Advocate must be native fluent bilingual in Spanish and will support members in all time zones throughout the United States. Some evening hours and weekend hours are required.

Member Support and Engagement

• Effectively service and maintain an assigned caseload of up to 125 high acuity managed members, which includes development and maintenance of rapport with managed members through telephonic or video coaching as well as a pulse on their health status and disease progression indicators through initial and ongoing assessments.
• Outreach to providers to obtain pertinent member treatment/health record information and assist with coordination of Care.
• Complete member education calls to support the long‑term success of members engaged in the Renal Advocate program, including establishment of personal and clinical goals and education on key topics related to disease progression
• Provide support to members with barriers related to social determinants of health.
• Request/receive member PHI and ensure all information is appropriately documented/shared. Clinical and administrative information should always be documented in the appropriate clinical system in real time while communicating with the member. Nurses are responsible for accurate and timely documentation.
• Adhere to workflows and processes that support meeting reporting requirements, NCQA guidelines as well as align with established care paths and intervention protocols for optimal clinical and financial outcomes
• Provide short‑term advocacy and navigation to members that are not participating in a clinical program (risk pool) in order to support the operations of the Dialysis (Cost Containment) team.
• Identify and share potential methods of increasing member engagement.
• Support team KPIs and corresponding individual metrics relating to areas outlined below:
  • Unplanned start to dialysis
  • Lab Adherence
  • Member Engagement/Coaching Rate
  • Controllable Churn

Client Support

• Manage escalations that require client intervention and deliver to Sr. Director of Member Advocacy in real time.
• Assist Client Service Managers with the collection of member success stories, cost savings, program outcomes, successful referrals, and successful closed care gaps.
• Assess members at risk utilizing claims data and clinical expertise, document findings, and make appropriate notifications to internal and external stakeholders promptly.
• Notify Integrated Care Nurse and Sr. Director of Member Advocacy of members with significant risk that could result in high‑cost claims.

Behavioral Expectations

• Maintain an appreciation of how your…