Remote Nurse Navigator (LVN or RN)

Job Title: Nurse NavigatorLocation: RemoteType: Full-TimeAbout Us:Trinity Care Navigation, part of the Trinity Captive Group, is redefining healthcare delivery by combining compassionate clinical support with innovative cost-management strategies. Our mission is to simplify the healthcare journey for members while helping employers achieve measurable savings through proactive, data-driven navigation. The Nurse Navigator plays a critical role in guiding members with complex or high-cost medical needs through their healthcare journey—providing clinical expertise, coordination, and education to improve outcomes and reduce costs.Key Responsibilities:Clinical Guidance & Support• Serve as a clinical resource for members navigating high-cost or complex healthcare conditions, including surgical, infusion therapy, oncology, and specialty medication cases. • Provide education on diagnoses and treatment options,• ensuring members understand their next steps and available support. • Identify opportunities for care optimization such as site-of-care redirection, second opinions, and bundled services. Care Coordination• Collaborate with providers, TPAs, and other partners to coordinate timely, high-quality care for members.• Schedule and track services, follow-up appointments, and transitions of care to ensure continuity. • Partner with Patient Navigation Coordinators to ensure a seamless member experience from intake through resolution. Cost Management & Steerage• Review claims and utilization data to identify high-cost or emerging large-claim cases. • Engage members proactively to discuss alternative care pathways, cost-effective providers, and programs that align with plan design. • Track and document savings and clinical outcomes related to steerage and coordination efforts.Documentation & Compliance• Maintain accurate and timely documentation of all interactions in accordance with Trinity Care Navigation standards and HIPAA requirements. • Ensure all clinical recommendations are evidence-based and compliant with plan guidelines and policies. Qualifications:• Active Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license, in good standing, in State of Texas. • Minimum 3–5 years of clinical experience in one or more of the following: case management, medical/surgical, or oncology.• Strong understanding of healthcare systems, claims data, and cost-containment principles. • Excellent communication and critical-thinking skills, with the ability to engage both clinically and compassionately. • Experience working with self-funded employer groups, TPAs, or stop-loss carriers preferred. • Bilingual (Spanish) is a plus. Skills:• Strong clinical judgment and critical thinking abilities. • Excellent communication and interpersonal skills for interacting with patients, families, and healthcare providers.• Proficient in using electronic health records (EHR) and case management software. • Ability to work independently in a remote environment, managing multiple cases simultaneously. Why Join Trinity Care Navigation? Be part of a purpose-driven team transforming how healthcare is delivered and financed. We offer a collaborative, remote work environment, competitive compensation, and opportunities to make a measurable impact—helping members achieve better outcomes while supporting cost savings for our clients.Apply tot his job