Clinical Care Specialist - RN
The Clinical Care Specialist is a registered nurse who proactively engages Lantern members who have the surgical benefit and guides them to high-quality providers within our Centers of Excellence (COE). Navigators support members across our five service lines: spine/pain management, orthopedics, joint replacement, gynecology, bariatric surgery. They combine clinical expertise with a service-oriented approach, helping members understand their options, feel confident in their choice of provider, and prepare for a successful surgical journey.
By guiding members to proven, high-quality providers, this role drives better clinical outcomes and member experience, and delivers meaningful cost savings for employers and payors.
Location: Dallas, TX or New York, NY - Hybrid schedule (3x in office per week)
Responsibilities:
- Conduct proactive outreach to eligible members to introduce the Lantern surgical benefit, explain its value, and encourage engagement.
- Guide members to the appropriate Center of Excellence (COE) provider based on their clinical needs, preferences, and the quality of the provider network.
- Apply specialty knowledge to answer clinical questions and explain what to expect before, during, and after surgery.
- Review member information to confirm that provider recommendations are clinically appropriate.
- Educate members and their families on surgical preparation, recovery, and the importance of following discharge instructions.
- Serve as a clinical resource for internal care advocates and customer care teams on provider selection and specialty-specific questions.
- Collaborate with Lantern Clinical Leadership and the Medical Advisory Board on complex or escalated cases.
- Support ongoing training of frontline care advocates on the surgical care landscape.
- Assess member understanding throughout the process to ensure effective engagement and informed decisions.
Requirements:
- Registered Nurse with an active Texas or NY state license in good standing, with unencumbered ability to hold a license in all fifty states preferred. (BSN preferred)
- Licensed Practical Nurse or Medical Assistant with active Texas or NY state license in good standing with unencumbered ability to hold a license in all fifty states considered.
- Med-surg background with office/clinic experience in bariatric, GYN, ortho, joint replacement, spine, or pain mgmt.
- Nurse navigation, case management, or UR a plus.
- Prior customer service, call center, member engagement, or patient-facing communication experience.
- Excellent verbal communication, with empathy, active listening, and the ability to build rapid rapport with members by phone.
- Ability to explain complex clinical information in clear, plain language.
- Strong critical thinking and problem-solving skills for navigating complex member situations.
- Comfort with outbound calling and with motivating members toward informed decisions.
- Strong command of medical terminology, anatomy, and physiology.
- Proficiency in Microsoft Office (Word, Excel, Outlook, Teams) and in documenting in CRM or care management systems.
- Ability to work with data sources and reports to inform member conversations.
- Knowledge of healthcare regulations and compliance standards.
- Bilingual (English/Spanish) preferred but not required.
Strong Candidates will:
- Manage a high volume of outbound and inbound member calls with empathy, professionalism, and a focus on quality-driven provider recommendations.
- Meet or exceed engagement, conversion, and quality metrics set by management, and document member interactions accurately and on time.
- Identify trends, barriers, and opportunities to increase member selection of COE providers, and share insights with leadership.
- Collaborate cross-functionally to ensure members receive clear, consistent, and accurate information.
- Maintain strict confidentiality and adhere to HIPAA and all applicable regulatory and compliance standards.
- Manage time and priorities effectively in a fast-paced environment.
Benefits
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Short & Long Term Disability
- Life Insurance
- 401k with company match
- Paid Time Off
- Paid Parental Leave
Compensation: Base salary range: $85,000 - $95,000 plus bonus, depending on relevant experience, location, and qualifications.