Abby Care

Title: TN - RN Case Manager Location: Nashville Department: Clinical Compensation - $80K – $84K Abby Care believes in fair and equitable compensation practices. Actual compensation packages are based on several factors unique to each candidate's experience and professional leveling; it is not typical for an individual to be hired at or near the top of the range. These factors include, but are not limited to: - Job-related knowledge and specialized skill sets - Depth of industry experience - Relevant certifications, degrees, and licensures - Specific work location and market data Job Description: About Abby Care: Powering the future of care at home for all of America. Abby Care is building the leading AI-native platform for family-led care. America is facing a growing care crisis. Millions more people need care at home than ever. Over 50 million family caregivers support loved ones without the tools, training, or recognition they deserve. We believe families are the largest untapped caregiving workforce in America, and that technology can help them deliver better care while driving stronger outcomes and greater transparency across the healthcare system. Abby Care combines clinical oversight with an AI-powered platform to train, enable, and support family caregivers in delivering high-quality care at home. Our platform helps health plans and government partners better understand, verify, and improve care in the home. We expand access to care, reduce reliance on higher-cost settings, and help ensure public dollars are spent effectively. We are proud to partner with leading health plans, providers, and community organizations and are backed by top VCs. We envision a future where family-led care is a core part of the healthcare system. Abby Care is building that future. Join us in solving one of the most important challenges of our time. The Opportunity: As our RN Case Manager, you will oversee the comprehensive care and coordination of services for patients within your caseload, reporting directly to the Director of Nursing in Tennessee. In this high-agency role, you will hold high-level deliverables centered on managing patient care plans, providing critical clinical oversight to Home Health Aides (HHAs) and Certified Nursing Assistants (CNAs), and collaborating closely with families, primary care physicians, and therapy providers to ensure optimal, compassionate patient outcomes. A true advocate and clinical leader, you are equally comfortable managing diverse clinical caseloads as you are educating families on complex care plans. Detail-oriented and highly organized, you have a passion for maintaining rigorous electronic documentation and possess the adaptive communication skills required to seamlessly coordinate across multi-disciplinary healthcare teams. This is a Full-Time Hybrid opportunity based in Nashville, TN. What you’ll work on: - Coordinate comprehensive patient care: Manage a diverse caseload, collaborating with PCPs, therapy providers, and internal support teams to drive optimal clinical outcomes. - Provide clinical oversight: Coach, supervise, and support Certified Nursing Assistants (CNAs) to ensure strict adherence to clinical standards and the highest quality of patient care. - Develop individualized care plans: Design, implement, and adjust custom care plans tailored to patient-specific assessments and health goals. - Maintain timely documentation: Execute accurate electronic charting with a preference for real-time documentation, ensuring a minimum of 24-hour turnaround time in alignment with regulatory standards. - Support and educate families: Provide critical health education and compassionate support to patients and their families regarding treatment plans and healthcare needs. - Manage clinical escalations: Identify and escalate appropriate issues, such as order management and immediate patient concerns, to Clinical Leads in a timely manner. - Participate in clinical rotations: Support the team by participating in on-call rotations (approximately one weekend per month), holiday rotations, and weekday phone triage night coverage as needed. - Drive quality assurance: Monitor and actively work to improve patient readmission rates while maintaining top-tier caregiver and patient satisfaction. - Ensure administrative accuracy: Keep extended clinical visits within acceptable ranges and complete administrative tasks, including mileage reimbursements, thoroughly. What success looks like: In 12 months, the RN Case Manager will have successfully managed and optimized their patient caseload, maintaining a high standard of clinical documentation with consistent under-24-hour turnaround times. They will have built strong, trusting relationships with patients, families, and external providers, leading to measurable improvements in caregiver satisfaction and a reduction in patient readmission rates. What you’ll have: Required Qualifications: - Education: Associate's Degree in Nursing or a Baccalaureate School of Nursing Degree (BSN). - Licensure: Current, valid, and unencumbered license as a Registered Nurse (RN) in the state of TN, or a valid Compact/Multi-state RN License. - Experience: Minimum of 2 years of clinical experience as a Registered Nurse. - Transportation: Access to reliable transportation, a valid driver's license, and current auto insurance to facilitate local travel. - Scheduling Flexibility: Ability to work flexible hours, travel locally to patient locations, and participate in on-call and weekend rotations. - Location: Must reside or be willing to permanently relocate to the Nashville, TN area. Preferred Qualifications: - Home Health Experience: 1+ years of home health experience. - Leadership: Prior clinical case management or supervisory experience. - Clinical Specialization: Experience in pediatric or adult home care. - Program Knowledge: Understanding of the Medicaid paid family caregiving program and the CNA scope of practice (training will be provided if needed). - Assessment Tools: Familiarity with OASIS documentation standards (training will be provided if needed). Benefits: - Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work – full-time employees are eligible for an annual company performance bonus. - Comprehensive health coverage that works for you. Choose from high-quality medical dental and vision options, including a $0 deductible PPO and a company-funded HSA, alongside employer-paid life and disability insurance. - Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays. - Financial savings benefits to support your future. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered). - Paid parental leave to support your growing family. We provide paid leave, so you can focus on bonding and adjusting to life as your family grows. Our Values - Families First Redefining healthcare starts with how we treat the parents and children we serve. We go above and beyond for every family, building strong, lasting relationships. We continually ask ourselves, “Would we want this for our own families?” - Urgency with Precision Millions of families are waiting for care, and they cannot wait, therefore this is not your typical 9 to 5 job. We match their urgency with our own, delivering exceptional care without compromise. Here, speed and excellence go hand in hand. - Relentlessly Resourceful As an ambitious startup, we adapt quickly and make the most of limited time and resources. We solve challenges with creativity to deliver results without unnecessary complexity. - Purpose with Positivity We take our mission seriously while never losing sight of the people behind the work. Respect, kindness, memes, and coffee make us stronger as a team and better for the families we serve. - Driven to Redefine What’s Possible We are here to make healthcare better, which means asking hard questions, challenging outdated systems, and finding smarter, more compassionate ways to deliver care. Automated Decision Tools Abby Care may use automated decision tools to help match and rank candidate work experience, education and skills found in online profiles, resumes and job applications against job requirements. We believe that these tools help ensure objective, data-based decisions during the hiring process, however, all Abby Care hiring decisions involve final human review and input. If you have questions or would like to request an alternative process, contact talent@abbycare.org.

• Review and verify clinical documentation required for claim submission. • Audit home health documentation, including Electronic Visit Verification (EVV), Face-to-Face (F2F) encounters, Plans of Care (CMS-485). • Ensure documentation meets payer and regulatory requirements before billing. • Review EVV records for completeness and accuracy. • Identify missing documentation or discrepancies and coordinate resolution. • Submit EVV data through Medicaid portals and monitor submission status. • Investigate documentation issues that contribute to claim denials. • Partner with billing and operational teams to resolve discrepancies efficiently. • Help minimize billing delays through proactive quality assurance. • Assist with inquiries related to Prior Authorization Requests (PAR) and reauthorizations. • Maintain accurate tracking of billing activities and patient documentation. • Update internal systems to ensure real-time visibility into billing workflows. • Communicate market- or payer-specific billing changes with internal billing teams. • Work closely with Clinical, Operations, and Revenue Cycle teams to resolve documentation issues affecting billing. • Respond professionally and promptly to inquiries from internal stakeholders and payers.

• Guide Caregivers Through the Intake Process • Conduct inbound and outbound calls with caregivers who have applied to Abby Care. • Guide caregivers through a detailed intake process lasting approximately 20–30 minutes. • Clearly explain Abby Care's services and answer questions with confidence and empathy. • Encourage and support caregivers who may be undecided about joining the program. • Follow up with caregivers via phone, SMS, and email regarding missing information or next steps. • Build Meaningful Relationships • Serve as the primary point of contact until caregivers transition to the next stage of onboarding. • Provide exceptional customer service through every interaction. • Build trust by maintaining a compassionate, professional, and patient approach. • Manage CRM & Administrative Tasks • Document all caregiver interactions accurately in Salesforce and other internal systems. • Maintain organized records and ensure timely follow-ups. • Collaborate closely with Nurses, Care Operations, and other cross-functional teams to ensure a seamless caregiver experience. • Support Continuous Improvement • Share feedback on existing workflows and suggest process improvements. • Adapt quickly as systems and processes evolve within a fast-growing startup environment.

• Collect, review, and track required documentation from families and caregivers • Support the insurance approval process by obtaining and validating required documents • Manage a high volume of inbound and outbound calls with families, doctors' offices, and insurance companies (50–70 calls per day) • Guide families through documentation requirements and next steps • Ensure documentation is accurate, complete, and compliant with Medicaid, Medicare, and state regulations • Maintain organized records and monitor document expiration dates • Send timely follow-ups and reminders to families and external stakeholders • Communicate professionally via phone, email, and text • Collaborate with onboarding, credentialing, and family support teams • Escalate issues that may delay approvals or impact family onboarding

Title: Care Operations Manager Location: Boston Department: Operations Job Description: About Abby Care: Powering the future of care at home for all of America. Abby Care is building the leading AI-native platform for family-led care. America is facing a growing care crisis. Millions more people need care at home than ever. Over 50 million family caregivers support loved ones without the tools, training, or recognition they deserve. We believe families are the largest untapped caregiving workforce in America, and that technology can help them deliver better care while driving stronger outcomes and greater transparency across the healthcare system. Abby Care combines clinical oversight with an AI-powered platform to train, enable, and support family caregivers in delivering high-quality care at home. Our platform helps health plans and government partners better understand, verify, and improve care in the home. We expand access to care, reduce reliance on higher-cost settings, and help ensure public dollars are spent effectively. We are proud to partner with leading health plans, providers, and community organizations and are backed by top VCs. We envision a future where family-led care is a core part of the healthcare system. Abby Care is building that future. Join us in solving one of the most important challenges of our time. The Role We are looking for a strategic, data-driven, and highly organized individual to join us as a Care Operations Manager. This role will report into the General Manager of Massachusetts. This is a Full-Time Hybrid position based in Boston, Massachusetts. In this role you will own the systems, people, and processes behind every step of the care journey from documentation and onboarding to scheduling and ongoing service coordination. You will manage a diverse, cross-functional, international team across operational specialties, drive operational efficiency, and directly influence our ability to retain and support families over time. The Requirements: - Bachelor's or Associate's Degree in a related field - 5+ years of operations or care delivery leadership experience - Proven track record managing both local and international teams - Strong analytical and reporting skills - Ability to work hybrid out of our Boston, MA office - A background in healthcare or familiarity with Medicaid-based programs is preferred Key Responsibilities: - Care Delivery Oversight - Lead the day-to-day execution of Abby Care’s care delivery engine. You’ll oversee onboarding, HR coordination, documentation, scheduling, and service support. You’ll be responsible for ensuring that every part of the care journey runs smoothly and consistently, building trust with families and enabling clinicians to focus on care. - Team Leadership - Manage a high-performing team across multiple care operations functions both U.S.-based and international. You’ll be responsible for hiring, training, and retaining top talent, while fostering a culture of urgency, compassion, and accountability. Your leadership will shape not only outcomes but the team’s development and cohesion. - Data & Metrics Management - Establish and track operational KPIs that allow us to monitor performance at every stage from onboarding timelines to family retention. Your data insights will guide consistent operational improvements, strategic decisions and help identify and address inefficiencies before they become blockers. - Process Design & Scalability - Create and refine SOPs, implement workflow automation, and optimize handoffs between teams to reduce delays and increase throughput. Your infrastructure will serve as the operational backbone as we expand into new cities and care models. - Cross-Functional Collaboration - You will work closely with Clinical, Care Experience, Technology, Product, and Compliance teams to ensure end-to-end alignment and success. From feature requests to operational launches, you’ll help orchestrate the internal coordination needed to deliver exceptional care at scale. - Compliance & Quality Control -You’ll own HIPAA and Medicaid compliance across operations, as well as internal documentation standards. This includes supporting audits, refining QA processes, and ensuring operational integrity is maintained across every touchpoint. Benefits: - Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work. - Comprehensive health coverage that works for you. Choose from high-quality medical dental and vision options, including a $0 deductible PPO and a company-funded HSA, alongside employer-paid life and disability insurance. - Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays. - Financial savings benefits to support your future. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered). - Paid parental leave to support your growing family. We provide paid leave, so you can focus on bonding and adjusting to life as your family grows. We are an equal opportunity employer and welcome applicants from all backgrounds, consistent with applicable laws. Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation. Our Values - Families First Redefining healthcare starts with how we treat the parents and children we serve. We go above and beyond for every family, building strong, lasting relationships. We continually ask ourselves, “Would we want this for our own families?” - Urgency with Precision Millions of families are waiting for care, and they cannot wait, therefore this is not your typical 9 to 5 job. We match their urgency with our own, delivering exceptional care without compromise. Here, speed and excellence go hand in hand. - Relentlessly Resourceful As an ambitious startup, we adapt quickly and make the most of limited time and resources. We solve challenges with creativity to deliver results without unnecessary complexity. - Purpose with Positivity We take our mission seriously while never losing sight of the people behind the work. Respect, kindness, memes, and coffee make us stronger as a team and better for the families we serve. - Driven to Redefine What’s Possible We are here to make healthcare better, which means asking hard questions, challenging outdated systems, and finding smarter, more compassionate ways to deliver care.

• Collect, review, and track required documentation from families and caregivers • Support the insurance approval process by obtaining and validating required documents • Manage a high volume of inbound and outbound calls with families, doctors' offices, and insurance companies (50–70 calls per day) • Guide families through documentation requirements and next steps • Ensure documentation is accurate, complete, and compliant with Medicaid, Medicare, and state regulations • Maintain organized records and monitor document expiration dates • Send timely follow-ups and reminders to families and external stakeholders • Communicate professionally via phone, email, and text • Collaborate with onboarding, credentialing, and family support teams • Escalate issues that may delay approvals or impact family onboarding

• Serve as the primary point of contact for caregivers and families via phone, text, and email. • Guide caregivers through the onboarding process, training milestones, required documentation, and program requirements. • Manage an active caseload of caregivers, ensuring timely completion of onboarding tasks and successful transition into active care. • Provide ongoing support to enrolled families by answering questions, resolving concerns, and coordinating requests with internal teams. • Coordinate care logistics, including scheduling Start of Care (SOC) visits, training sessions, and other caregiver appointments. • Maintain accurate documentation and caregiver records across internal systems. • Monitor caregiver progress, proactively follow up on outstanding requirements, and remove barriers that may delay onboarding or care delivery. • Communicate caregiver feedback and family concerns with clinical, operations, and support teams to ensure timely resolution. • Handle a high volume of daily communication through calls, text messages, and email while maintaining exceptional service quality. • Educate caregivers and families on program processes, expectations, and available resources in a clear and supportive manner. • Help improve caregiver engagement by providing encouragement, coaching, and proactive follow-up throughout their journey. • Collaborate cross-functionally to improve operational workflows and enhance the caregiver experience.

Role Description The Intake Nurse serves as the clinical gatekeeper for new referrals and prospective clients, ensuring patients meet payer, regulatory, agency, and clinical eligibility requirements before admission. This role collaborates closely with referral sources, family growth associates, case managers, business development teams, and clinical leadership to evaluate referrals, assess patient needs, determine service appropriateness, and support timely admissions. The Intake RN uses clinical judgment to identify patients who qualify for skilled nursing, home health aide, personal care, paid family caregiver, or other agency services while ensuring compliance with state regulations, payer requirements, and agency policies. This role reports directly to the Director of Nursing for the agency. Key Responsibilities - Review incoming referrals, leads, and prospective patient inquiries for clinical appropriateness. - Evaluate medical records, physician orders, diagnoses, medications, treatment plans, and supporting documentation. - Determine whether requested services meet agency admission criteria and payer requirements. - Assess eligibility for skilled nursing, personal care, home health aide/family caregiver, or specialty programs. - Identify clinical risks, safety concerns, and service limitations that may impact admission. - Escalate complex clinical cases to the Director of Nursing or Clinical Leadership as needed. - Document qualification decisions and rationale for tracking purposes. Clinical Lead Management - Conduct telephone-based clinical screenings with patients, caregivers, referral sources, and physicians. - Gather missing clinical information needed to complete qualification reviews. - Verify functional limitations, care needs, diagnosis history, medication management needs, and caregiver support systems. - Prioritize referrals based on urgency, acuity, and service availability. - Maintain timely response times for all incoming leads. Payer & Regulatory Compliance - Verify referrals meet Medicare, Medicaid, managed care, private duty, and agency-specific requirements. - Ensure physician documentation and orders support requested services. - Maintain knowledge of state regulations, home health conditions of participation, and payer authorization requirements. - Assist with prior authorization clinical documentation as needed. Admission Coordination - Collaborate with scheduling and operations teams to coordinate Start of Care (SOC) visits. - Work with FGAs to communicate admission decisions to referral sources and internal stakeholders. - Ensure all required documentation is completed prior to admission. - Support smooth handoff to assigned case managers and field clinicians. Quality & Process Improvement - Monitor referral outcomes and identify trends affecting admissions. - Participate in intake process improvement initiatives. - Assist with development and maintenance of admission criteria and clinical screening tools. - Support quality assurance audits related to intake documentation. Qualifications - Active RN license in applicable state(s). - Minimum 5 years of nursing experience. - Minimum 1 year experience in home health, hospice, case management, utilization review, intake, or care coordination. - Strong clinical assessment and critical thinking skills. - Knowledge of Medicaid, Medicare, and home health regulations. - Excellent verbal and written communication skills. - Experience reviewing medical records and clinical documentation. - Proficiency with EMR systems and Google Office. Preferred - Pediatric home health experience. - Family caregiver program experience. - Prior authorization or utilization management experience. - Bilingual capabilities. Benefits - Competitive compensation packages that reflect the value you bring. - Comprehensive health coverage that works for you. - Generous paid time off, including 10 paid company holidays. - Financial savings benefits to support your future. - Paid parental leave to support your growing family.

Role Description We are seeking a highly organized and compassionate Document Collection Associate to support our onboarding and credentialing processes. In this role, you will be responsible for collecting, reviewing, and managing critical documentation from caregivers and families while ensuring compliance with healthcare regulations. This is a fast-paced, phone-heavy role ideal for someone who thrives in high-volume environments and is passionate about delivering a smooth and supportive experience for families. - Collect, review, and track required documentation (e.g., IDs, certifications, health records) from caregivers and families - Make outbound calls and handle inbound inquiries to guide families through the documentation process - Manage a high volume of daily calls (50–70) with professionalism, empathy, and efficiency - Ensure all documentation is accurate, complete, and compliant with state and Medicaid/Medicare requirements - Communicate clearly and compassionately via phone, email, and text - Maintain organized records and track expiring documents, sending timely follow-ups and reminders - Collaborate cross-functionally with onboarding, credentialing, and family support teams Qualifications - 2+ years of experience in customer service, administrative support, or healthcare operations - Proven experience handling high-volume inbound and outbound calls in a fast-paced environment - Proficiency with CRM systems, shared drives, and document tracking tools - Strong organizational skills and exceptional attention to detail - Ability to multitask, prioritize follow-ups, and meet deadlines - Compassionate, patient, and professional communication style - Fluent in both English and Spanish - Experience with prior authorizations or healthcare operations - Familiarity with healthcare documentation standards, HIPAA, or Medicaid - Experience using tools such as Salesforce, Slack, Google Drive, or similar platforms Benefits - Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work – global team members are eligible for an annual company performance bonus. - Generous paid time off. We provide 15 days of paid time off that allow you to recharge, along with 10 paid company US holidays. - Team bonding. We love bringing our teams together. As a full-time employee, you’ll get to connect, collaborate, and have fun through team activities and our annual company retreat. - Set Up for Success. We provide a company-issued laptop to support you in your role. - Growth Opportunities. Build your leadership skills while working with teams in various markets across the US. Company Description Abby Care is building the leading AI-native platform for family-led care. America is facing a growing care crisis. Millions more people need care at home than ever. Over 50 million family caregivers support loved ones without the tools, training, or recognition they deserve. We believe families are the largest untapped caregiving workforce in America, and that technology can help them deliver better care while driving stronger outcomes and greater transparency across the healthcare system. Abby Care combines clinical oversight with an AI-powered platform to train, enable, and support family caregivers in delivering high-quality care at home. Our platform helps health plans and government partners better understand, verify, and improve care in the home. We expand access to care, reduce reliance on higher-cost settings, and help ensure public dollars are spent effectively. We are proud to partner with leading health plans, providers, and community organizations and are backed by top VCs. We envision a future where family-led care is a core part of the healthcare system. Abby Care is building that future.

• Own relationships with Medicaid MCOs, Medicare Advantage plans, and commercial health plan partners across current and target markets • Lead contract negotiations for new market entries, rate increases, and value-based program structures • Define and execute the company's payor roadmap: which plans to prioritize, on what terms, in what market sequence • Build the payor infrastructure from the ground up: reporting cadences, performance dashboards, quality tracking, and plan-facing analytics • Partner with clinical leadership to design and articulate an outcomes story that resonates with what health plans actually care about • Work with finance to model contract economics, pressure-test rate assumptions, and protect margin at scale • Represent Abby Care at health plan meetings, state conferences, and industry forums