Summary
The Health Navigator helps our members move through the healthcare system through educating members and their families about their diseases and treatments, translating medical jargon into readily accessible terms, and helping members navigate the healthcare system and processes and overcome any barriers to healthcare that they may face.
Essential Job Responsibilities
Clinical Required: Provide patient care, treatment, and services within the scope of their license, certification or registration and as required by Federal and State laws and regulations.
Support and navigate patients throughout the healthcare system
Performs nursing assessments and triage of member care needs for new and ongoing members
Central point of contact for all navigated members including interaction with medical, nursing, ancillary services, and pharmacy needs
Provides education to members about their diagnoses, treatments, medications, overall health
Guides members through their health care journey, simplifying the labyrinth of health care while being a liaison with providers, insurance companies, health systems and supplier of health care to maximize cost, quality and satisfaction.
Collect and report data from member on barriers, health care, medications, prior treatments, etc.
Track order completion and follow up. Monitor member compliance with member treatment plan.
Assist members with referrals to outside resources and care coordination as needed.
Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives and safety, environmental, and/or infection control standards.
Collaborates with medical providers, member care staff and clinic management in the planning and implementation of member and staff education.
Functions as an advocate and maintains confidentiality. Educate the member, the family, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, case management, etc., so that timely and informed decisions can be made.
Promote member self-advocacy, choice, and self-determination. Educate members and their families regarding the appropriate use of health care services. Improve quality of care and maintain cost effectiveness on a case-by-case basis.
Provides care navigation services to insured members and their family:
Receives telephone calls or other inquiries from the employee or family, evaluates the current problem and develops a plan of care accordingly
Collaborates with third party administrator (TPA) and other external service providers
Assists with accessing appropriate level of care
Follows up post access to care to evaluate outcomes
Provides oversight of chronic medical conditions
Research best practice, high quality care
Investigates costs associated with all aspects of care (procedures, labs, medications, surgeries, etc.)
Coordinates referrals as needed
Research information on health concerns
Advocates for the most appropriate care at the most appropriate time
Empowers members through information and support to make informed decisions
Communicate with members to promote participation in the development and execution of the plan of care
Designs or participates in the creation of health education materials.
Performs miscellaneous job-related duties as assigned.
Reports clinically to the supervising physician in Employee Health.
Embrace Diversity, Equity and Inclusion, by:
Treating everyone with dignity and respect
Opening more doors to opportunities for underrepresented cultures
Growing talent and people
Evaluating and eliminating disparities
Taking action against injustices, bias and racism
Honoring our differences and how to collaborate
Educating staff, patients and the communities we care for
Restoring Hope and Freedom, together
Essential Job Qualifications
Licensure: Registered nurse in the state of Michigan.
Education: Associates degree in nursing is required. Bachelor's degree preferred.
Current Basic Life Support (BLS) certification
Sound knowledge of the healthcare system and where to find reliable information.
Excellent verbal and written communication skills.
Excellent interpersonal skills
Must be able to work effectively under time requirements and deadlines, problem-solve when facing unexpected issues, handle interruptions, and prioritize effectively.
Preferred Job Qualifications
Prior experience in health navigation
Experience with health insurance claims management
Physical Requirements for Essential Job Qualification
Levels:
None (No specific requirements)
Occasionally (Less than 1/3)
Frequently (1/3 to 2/3)
Majority (More than 2/3)
Remain in a stationary position: aMajoritya
Traverse or move around work location: aOccasionallya
Use keyboard: aFrequentlya
Operate or use department specific equipment: aNonea
Ascend/Descend equipment or ladder: aNonea
Position self to accomplish the Essential Functions of the role: aNonea
Receive and communicate information and ideas for understanding: aMajoritya
Transport, position, and/or exert force:
Up to 10 pounds: aOccasionallya
Up to 25 pounds:a_____a
Up to 50 pounds:a_____a
Up to 75 pounds: a_____a
More than 100 pounds:a_____a
Other weight: Up to___ pounds a_____a
Other:a_____a
The above statements are intended to describe the general nature and level of work being performed by employees in this classification. If you require a reasonable accommodation to perform the essential functions of this position, you must request accommodation in writing, within 182 days after you know or should know of the need for accommodation.
Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.
