Job Description

Join the 5G Benefits & InterceptCare® Team!

The InterceptCare Nurse serves as a trusted healthcare advocate and navigator for employees and their families. This role helps members understand their health plan, navigate the healthcare system, identify high-quality and cost-effective care options, and coordinate services with preferred and direct-contracted providers.

The InterceptCare Nurse works directly with members, employer groups, providers, TPAs, pharmacy partners, and other healthcare vendors to remove barriers to care while helping members make informed healthcare decisions. The goal is to provide a personalized, high-touch experience that improves access to care, reduces unnecessary healthcare spending, and ensures members receive the right care at the right place and cost.

Our ideal candidate will be located within a 45-mile radius of Fond du Lac/Oshkosh as there will be some travel required to/from clients in the area.

Key Responsibilities

Member Advocacy & Navigation

• Serve as a primary point of contact for members who need assistance navigating healthcare services.
• Educate and help members understand their healthcare options so they can make informed decisions based on quality, cost, convenience, and personal preference.
• Provide individualized support for members facing new diagnoses, surgeries, specialty care, chronic conditions, or other complex healthcare needs.
• Advocate for members when barriers or administrative issues are preventing timely or appropriate care.
• Coordinate referrals to preferred and direct-contracted providers when appropriate.
• Assist members with scheduling imaging, procedures, specialty appointments, durable medical equipment, and other healthcare services.
• Coordinate the transfer of orders, medical records, imaging results, and other necessary information between providers when needed.
• Collaborate with provider offices to resolve referral, scheduling, prior authorization, and benefit-related concerns.
• Identify opportunities to redirect care to high-quality, lower-cost providers and facilities.
• Educate members on significant cost differences that may exist between healthcare facilities while respecting the member's right to choose where they receive care.
• Identify potential savings opportunities related to imaging, procedures, specialty care, medications, DME, and other high-cost services.
• Assist members experiencing challenges with specialty or high-cost medications.
• Coordinate with PBMs, specialty pharmacies, sourcing programs, providers, and other pharmacy partners when necessary.
• Help identify potential medication savings opportunities, including preferred pharmacies, alternative sourcing programs, and available biosimilars when appropriate.
• Develop and maintain strong working relationships with healthcare providers, TPAs, PBMs, DME vendors, direct-contract partners, and other healthcare organizations.
• Educate provider offices on InterceptCare referral and billing processes when necessary.
• Troubleshoot issues involving eligibility, billing, claims, contracting, prior authorizations, referrals, and member access.
• Provide education to employer groups and employees regarding InterceptCare services and available healthcare resources.
• Participate in employee benefit meetings, open enrollment meetings, onsite education sessions, health fairs, and individual member consultations.
• Develop strong relationships with HR teams and employer leadership while maintaining appropriate member confidentiality.
• Maintain accurate and timely documentation of member interactions, referrals, outreach, and outcomes.
• Assist with reporting on InterceptCare utilization, member outcomes, savings opportunities, and program effectiveness.
• Identify trends, recurring barriers, and opportunities to improve the member experience and overall program.

Qualifications

• Active Registered Nurse (RN) or Licensed Practical Nurse (LPN) license required.
• Clinical nursing experience required; experience in care coordination, case management, utilization management, population health, employee benefits, or healthcare navigation preferred.
• Strong understanding of healthcare terminology, medical procedures, medications, and common treatment pathways.
• Experience working with health insurance, self-funded health plans, TPAs, provider networks, prior authorizations, or claims is preferred.
• Strong communication, critical-thinking, problem-solving, and organizational skills.
• Ability to communicate complex healthcare and benefit information in a way that is understandable to members.
• Comfortable advocating for members and communicating with physicians, healthcare facilities, insurance partners, employers, and vendors.
• Ability to manage multiple member cases and priorities independently.
• Strong attention to detail and follow-through.
• Ability to handle confidential and protected health information appropriately.

What We Offer:

• Incentive bonus opportunities
• Hybrid work schedule with flexibility to work from home or the office
• 401(k) with a 4% dollar-for-dollar company match
• Health insurance
• Dental and vision coverage
• Employer-paid short-term disability, long-term disability, and life insurance

Why 5G Benefits & InterceptCare?

The ideal InterceptCare Nurse is compassionate, proactive, resourceful, and comfortable challenging the traditional healthcare process when a better option is available. This individual should enjoy problem-solving and working directly with members while also understanding the importance of healthcare quality, cost transparency, and responsible health plan utilization.

Most importantly, the InterceptCare Nurse should approach every interaction with a member-first mindset—helping individuals feel supported and confident navigating a healthcare system that can often be complicated and overwhelming.

Interested in joining us? We’d love to connect!

Email loryn@5gbenefits.com for additional information or to express interest.

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