Registered Nurse I - Surgery Care

About this role

The Registered Nurse I, Surgery Care reports to the Manager, Clinical Operations, Surgery Care and supports members through their Transcarent Surgery Care journey. This role combines foundational clinical judgment, member navigation, and operational coordination to ensure members receive timely, accurate, and high-quality support.

In this role, the RN I operates within a defined functional scope, either Surgery Care Coordination or COE Engagement. The RN I is responsible for executing established workflows, maintaining accurate documentation, and supporting case progression under defined standards. Through consistent application of Transcarent workflows and quality expectations, the RN I contributes to a seamless member experience.

The RN I upholds Transcarent’s mission, values, and quality by delivering clinically appropriate guidance, clear communication, and reliable follow-through while developing the skills needed to take on expanded responsibility over time.

What you’ll do
As a Registered Nurse I, Surgery Care, you will execute core Surgery Care workflows within your assigned function, applying clinical judgment, operational processes, and documentation standards to support members and provider partners. You will work within established guidelines while building proficiency, consistency, and confidence in your role.

Care Coordination

• Conduct clinical intake, ensuring accurate understanding of symptoms, history, risk factors, and surgery readiness
• Assess member appropriateness for the Surgery Care program and identify appropriate COE placement in accordance with established criteria
• Provide clear education to members regarding program requirements, next steps, timelines, and expectations
• Coordinate the full case pathway with support from internal partners, including scheduling, benefits, pre-authorization needs, and facility coordination
• Obtain, review, and validate required clinical documentation, forms, clearances, tests, consult notes, imaging, and consents
• Track case status and advance members through established workflows
• Maintain accurate and timely documentation of all interactions and decisions within internal systems
• Identify and escalate clinical risks, barriers, or workflow issues as appropriate

COE Engagement

• Serve as a clinical point of contact for assigned COEs, ensuring efficient communication from referral through post-op follow-up.
• Prepare and submit complete referral packets for COE review, confirming case receipt and monitoring review status.
• Obtain key updates including acceptance/denial decisions, consult dates, required next steps, and surgical approval items.
• Review and validate Case Approval Forms (CAF), following up on missing elements such as codes, TRDs, or facility information.
• Gather post-consult recommendations, clarify next steps, and ensure all requirements for surgical approval are met.
• Maintain accurate COE account records, contacts, and referral data within Salesforce.
• Partner with Clinical, PRE, AE, Medical Records, Scheduling, Benefits, Travel, Provider Relations, and Operations teams to resolve barriers and expedite care.
• Collaborate with internal clinical programs to ensure alignment and continuity of care.
• Participate in weekly operations meetings with COEs to support case progression and gain familiarity with provider workflows
• Serve as a resource to colleagues for routine case questions within assigned functional area

General

• Identify and escalate workflow gaps and proactively partner with leadership and peers to implement improvements
• Contribute to quality assurance efforts by evaluating clinical documentation, identifying issues, and escalating as appropriate.
• Uphold HIPAA, professional standards, and organizational policies while delivering clinically appropriate guidance.

Education Requirements

• BSN or RN with bachelor's degree
  • + Minimum of 3-5 yearsof Clinical Acute Care Experience; OR
• AAS or ADN degree
  • + Minimum of 5-6 yearsof Clinical Acute Care Experience

What we’re looking for

• Registered Nurse with active multi-state licensure.
• Clinical experience in surgery or a related specialty preferred.
• Strong written, verbal, and interpersonal communication skills with a service-oriented, member-first mindset.
• Proficiency in navigating multiple systems (Microsoft Office, EMRs, contact center platforms, Salesforce).
• Excellent organization, critical thinking, and problem-solving skills.
• High attention to detail and reliable follow-through across a high-volume caseload.
• Ability to remain focused, flexible, and effective in a fast-paced, evolving environment.
• Demonstrated adaptability to new workflows, tools, and technologies.

Nice to have

• Experience in multidisciplinary teams (care coordination, UM/CM, navigation, COE programs).
• Experience supporting members through high-stakes or emotionally complex clinical decisions.
• Skill in member-focused communication, motivation, and de-escalation.
• Familiarity with clinical documentation standards and ability to write clear, concise case notes.
• Experience collaborating across clinical, operational, and provider-facing teams.
• Comfort working in rapidly scaling or changing healthcare environments.
• Experience presenting clinical summaries or discussing clinical pathways in team settings.