Health Navigator - RN
Summary
TheHealthNavigatorhelpsour membersmovethrough the healthcare systemthrougheducatingmembers and their familiesabout their diseases and treatments, translating medical jargon into readily accessible terms, and helpingmembers navigatethe healthcaresystem andprocessesandovercome any barriers to healthcare that they may face.
Essential Job Responsibilities
Clinical Required: Providepatient care, treatment, and services within the scope of their license, certification or registration and as required by Federal and State laws and regulations.
Supportand navigatepatients throughout the healthcaresystem
Performs nursing assessments and triage ofmembercare needs for new and ongoingmembers
Central pointof contact for all navigatedmembers including interaction with medical, nursing, ancillary services, and pharmacy needs
Provides education tomembersabout 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, healthsystemsand supplier of health care to maximize cost,qualityand satisfaction.
Collect and report data frommemberon barriers, health care, medications, prior treatments, etc.
Track order completion and follow up. Monitormembercompliance withmembertreatment plan.
Assistmembers with referrals to outside resources andcarecoordination as needed.
Follows established departmental policies, procedures, andobjectives, continuous quality improvementobjectivesand safety, environmental, and/or infection control standards.
Collaborates with medical providers,membercare staff and clinic management in the planning and implementation ofmemberand staff education.
Functions as an advocate andmaintainsconfidentiality. Educate themember, the family, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, case management, etc., so thattimelyand informed decisions can be made.
Promote member self-advocacy,choice,and self-determination. Educate members and their familiesregardingtheappropriate useof health care services. Improve quality of care andmaintaincost effectiveness on a case-by-case basis.
Provides care navigation services to insuredmembersand their family:
Receives telephone calls or other inquiries from the employee or family, evaluates the currentproblemand develops a plan of care accordingly
Collaborates with third party administrator (TPA) and other external service providers
Assistswith accessingappropriate levelof care
Follows up post access to care to evaluate outcomes
Provides oversight of chronic medical conditions
Researchbest practice, high quality care
Investigatescosts associated with all aspects of care (procedures, labs, medications, surgeries, etc.)
Coordinates referrals as needed
Researchinformation on health concerns
Advocates for the mostappropriate careat the mostappropriate 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
Designsorparticipatesin the creation of health education materials.
Performs miscellaneous job-related duties as assigned.
Reports clinically to the supervising physician inEmployeeHealth.
We'llembrace all people by:
Treating everyone with dignity and respect.
Opening more doors to opportunity for others to succeed.
Growing talent and people.
Ensuring a welcoming experience for all we serve, regardless of origin, race, religion, disability, sexualorientationor socioeconomic status.
Taking actionagainst discrimination.
Honoring our differences and how we collaborate.
Educating staff,patientsand the communities we care for.
Restoring hope andfreedom,together.
Customer Service Responsibilities
Demonstrate excellent customer service and standards ofbehaviorsas well as encourages, coaches, andmonitorsthe sameinteam members. This individual should consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information.
Responsibilities in Quality Improvement
Contribute byidentifyingproblems and seeking solutions. Promote patient/family satisfaction where possible;participatesin departmental efforts tomonitorand report customer service.
Essential Job Qualifications
Licensure: Registered nurse in the state of Michigan.
Education:Associates degree in nursingisrequired. 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:Majority
Traverse or move around work location:Occasionally
Use keyboard:Frequently
Operate or use department specific equipment:None
Ascend/Descend equipment or ladder:None
Position self toaccomplishthe Essential Functions of... For full info follow application link.
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.
