Remote Utilization Review Rn Jobs in Monaca, PA (NOW HIRING)

The Care Advocate is an integral part of the member's care team and works closely with the clinicians and the clinical operations team. The Care Advocate will support our Care Delivery program (WiderCare+), using approved curriculum to build trust and promote health, while simultaneously driving the Community Health Integration (CHI) and Principal Illness Navigation (PIN) programs to bridge the gap between clinical care and social needs.

Wider Circle works with health plans and providers nationally to deliver unique community care programs that connect neighbors for better health. Centered on trusted relationships, Wider Circle connects health plan members with like-minded neighbors to inform, support and motivate one another, empowering them to be more proactive about their health. Wider Circle's trusted delivery network has been proven to drive resilience, improve member experience and engagement, and reduce inappropriate utilization and has been published in peer-reviewed literature. Today, Wider Circle offers its unique neighborhood care programs to tens of thousands of communities nationwide. To learn more, visit widercircle.com.

We are a mission-driven team dedicated to stabilizing high-risk populations and ensuring that no one falls through the cracks of the healthcare system.

Our mission is to integrate Case Management, Care Navigation, and Benefits Enrollment into a single seamless layer of support with a focus on patients and their Social Determinants of Health (SDOH).

This work bridges the gap between clinical requirements and social stability, and this role is vital to achieving that balance.

• Principal Illness Navigation (PIN): Execute person-centered care plans for patients with serious, high-risk illnesses. Assist in monitoring and revising disease-specific plans, especially when frequent adjustments in medication or treatment regimens are required.
• Clinical Care Bridge: Act as the link between the patient and the billing practitioner. Support care coordination by managing provider availability, rescheduling, and providing post-hospital discharge support.
• SDOH Assessment & Goal Setting: Conduct person-centered assessments to understand the patient's social and cultural context. Identify unmet social needs-such as food insecurity or housing instability-that impact the management of their serious condition and develop specific action plans to address them.
• System Navigation & Advocacy: Assist patients and caregivers in navigating the Pennsylvania healthcare landscape. Teach self-advocacy skills to help patients communicate effectively with specialists and coordinate transportation or access to telehealth.
• Technical & Workflow Support: Support patient communication templates and automation. Coordinate with the tech team to set up workflows, handle technical troubleshooting, and update patient charts in the Case Management System (CMS) with precision.
• Resource Coordination: Refer patients to supportive services and community-based resources. Establish and maintain partnerships with local Pennsylvania organizations to bring targeted resources (legal aid, food assistance, etc.) to our members' attention.
• Behavioral & Social Support: Use motivational interviewing and capacity-building to help patients manage the stress of chronic illness. Provide tailored education to improve treatment adherence and offer emotional support to families and caregivers.
• CMS Compliance & Documentation: Maintain detailed logs of all interactions, including the amount of time spent and specific activities performed. Ensure all documentation meets the standards required for Medicare clinical and social integration services.

• PA Locality: Safely and consistently drive to public places and member homes within a 50-mile radius in Pennsylvania.
• Remote Independence: Successfully work in a remote team environment with high independence and minimal oversight.
• Physical Presence: Frequently carry up to 30 pounds of supplies and stand/walk for the duration of home visits or member interactions.
• Digital Literacy: Ability to use a computer, tablet, and smartphone to update data in multiple secure systems with accuracy.

Requirements

• Community Health Worker (CHW) Certification preferred; candidates with a CHW background or completed CHW training are also strongly encouraged to apply.

• Compliance: Be willing to complete and maintain all CMS-mandated training and state-applicable requirements, including competencies in interpersonal building, service coordination, and professional ethical conduct.
• Experience: Have 3+ years of relevant community outreach, facilitation, or healthcare experience. Experience navigating high-risk chronic conditions or complex care management is a major plus.
• Technical Savvy: Have strong computer skills and the ability to navigate web-based and app-based systems with ease.
• Cultural Competency: Possess a deep understanding of the socio-economic and public health challenges facing disenfranchised populations in Pennsylvania.
• Communication: Have excellent written and verbal communication skills, with an outgoing personality and the ability to motivate and influence different types of people.
• Logistics: Have a high school diploma/GED (college degree preferred). Must have a valid driver's license, reliable transportation, and a flexible schedule for occasional work outside regular business hours.
• Commitment: Be committed to a drug-free workplace and ready for pre-employment substance abuse testing and background checks.

Benefits

As a venture-backed company, Wider Circle offers competitive compensation, including:

• Comprehensive health coverage, including medical, dental, and vision
• 401(k) Plan
• Paid Time Off
• Employee Assistance Program
• Health Care FSA
• Dependent Care FSA
• Health Savings Account
• Voluntary Disability Benefits
• Basic Life and AD&D Insurance
• Adoption Assistance Program
• Training and Development
• Compensation: $22.22 - $25.51 per hour

And most importantly, an opportunity to make the world a better place!

Wider Circle is proud to be an equal-opportunity employer that does not tolerate discrimination or harassment, of any kind. Our commitment to Diversity & Inclusion supports our ability to build diverse teams and develop inclusive work environments. We believe in empowering people and valuing their differences. We are committed to equal employment opportunity without consideration of race, color, religion, ethnicity, citizenship, political activity or affiliation, marital status, age, national origin, ancestry, disability, veteran status, sexual orientation, gender identity, gender expression, sex or gender, or any other basis protected by law.