Job Description

Vida is looking for a licensed RN or LPN to manage clinical review requests, escalations, and member inquiries in a fully remote, virtual care setting. You’ll analyze medical records, investigate concerns from members and internal teams, and see each case through to resolution. Along the way, you’ll help shape quality, safety, and process improvements across our clinical operations.

Responsibilities

• Intake, triage, track, and respond to clinical review requests, escalations, and inquiries in accordance with established service level agreements (SLAs).
• Review and analyze patient medical records, extracting relevant clinical information for presentation to providers and leadership as needed.
• Investigate and address clinical escalations originating from members, Member Support, Account Management, Clinical Operations, and other internal stakeholders.
• Respond to member inquiries professionally, compassionately, and in accordance with Vida clinical guidelines and program requirements.
• Collaborate closely with Providers, Clinical Assistants, and cross-functional teams to support continuity of care and efficient resolution of member concerns.
• Monitor cases through resolution and ensure timely follow-up and documentation.
• Support quality assurance initiatives by identifying trends, process improvement opportunities, and potential member safety concerns.
• Assist with provider performance monitoring, quality reviews, and operational audits as assigned.
• Maintain accurate, complete, and timely documentation within all required systems.
• Utilize provider messaging platforms, templates, workflows, and telehealth technologies efficiently and appropriately.
• Perform all duties within the scope of practice and in accordance with Vida clinical guidelines.
• Additional responsibilities as needed.

Qualifications

Preferred