Registered Nurse Care Guide

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The Nurse – Care Guide is an integral member of the LucyRx Care Guides team, dedicated to empowering members through personalized support, education, and advocacy. This role collaborates closely with Care Guides leadership and cross-functional teams to deliver innovative, high-touch programs that drive better health outcomes and member satisfaction. The Nurse – Care Guide champions member advocacy, leverages technology to enhance engagement, and fosters a culture of empathy, accountability, and continuous improvement.

Role and Responsibilities

Ensure compliance with HIPAA, state nursing practice acts, and organizational policies by safeguarding protected health information (PHI), practicing within RN scope of licensure, and adhering to approved clinical workflows, documentation standards, and escalation protocols.

Program Oversight:

• Actively contributes to the design and continuous improvement of Care Guide services, sharing feedback and insights from member interactions.

• Evaluate member eligibility for clinical programs, including but not limited to cancer, women’s health, diabetes, weight loss and biosimilar programs, based on clinical guidelines.

• Identify and address barriers to medication adherence to support successful outcomes.

Member Engagement:

• Champion a culture of empathy, accountability, and professional growth within the Care Guides team.

• Collaborate with members to establish individualized, patient centered goals and support longitudinal care management through follow up, education, and progress evaluation.

• Conduct nursing assessments to identify clinical needs, risks, and barriers to care; apply clinical judgment to determine appropriate education, support, and escalation within defined RN scope of practice.

• Identify changes in clinical status, symptom progression, or safety concerns and escalate appropriately to pharmacists, prescribers, or emergency resources in accordance with approved protocols.

• Educate members on proper medication use, potential side effects, and lifestyle changes.

• Provide motivational coaching to drive engagement with approved lifestyle vendors.

Navigation Support:

• Utilize technology and digital health platforms to enhance member engagement and track outcomes.

• Assist members in accessing resources to connect with clinical programs.

• Troubleshoot issues related to resource utilization and access.

Data Collection and Reporting:

• Document clinical assessments, member interactions, education provided, and care management activities accurately and timely within the designated clinical management system.

• Monitor and document member progress, ensuring treatment effectiveness in collaboration with pharmacists or prescribers.

• Collaborate with the analytics team to track outcomes and generate insights for clients

• Participate in ongoing training and development, including motivational interviewing and cultural competence.

Clinical Accountability

• Practice at the top of RN licensure while adhering to defined clinical scope and organizational guardrails.

• Maintain active licensure and participate in required training, competency validation, and quality assurance activities.

• Support continuous improvement through feedback, outcomes tracking, and adherence to evidence based standards.

Qualifications and Education Requirements

• Active multi-state Registered Nurse (RN) license.

• Experience in patient advocacy, member engagement, or health coaching.

• Exceptional communication and interpersonal skills.

• Experience working with diverse populations and addressing health disparities.

• Familiarity with weight management or diabetes programs preferred.

• Strong analytical and problem-solving skills and detail-oriented

• Ability to adapt and perform duties efficiently whenever unexpected changes arise

• Excellent organizational, written, and verbal communication

• Highly motivated and good interpersonal skills, self-starter

• Preferences

• Certified Diabetes Educator

• Certified Care Management

• Population Management Experience

• Hands-on and demonstrated experience in the Pharmacy Benefit Management (PBM) industry

• Knowledge of HIPAA regulations (this needs to be put in as a bullet of the job description itself, see additional first bullet above)

Physical Requirements

The physical demands described here are representative of those required by an employee to successfully perform the essential functions of this job. This is a largely sedentary role; however, some standing, walking, bending, and reaching may be required. Regularly operates in an office or home office setting, using a computer, mouse, and keyboard, and occasionally operate other standard office equipment, such as a printer, copier, and phone. Travel may be by car, airplane, or a combination of modes.