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Care Navigator RN
3 months ago
Healthcare Without Rival
Premise Health is the world's leading direct healthcare provider and one of the largest digital providers in the country, serving over 11 million eligible lives across more than 2,500 of the largest commercial and municipal employers in the U.S. Premise partners with its clients to offer fully connected care - in-person and in the digital environment. It operates more than 800 onsite and nearsite wellness centers in 45 states and Guam, delivering care through the Digital Wellness Center and onsite, nearsite, mobile, and event solutions.
Premise delivers value by simplifying complexity and breaking down barriers to give diverse member populations access to convenient, integrated, high-quality care. We offer more than 30 products, delivering the breadth and depth of care required to serve organizations' total populations. The result is healthcare that meets the needs of members and their families, helping them live healthier while lowering costs for organizations.
Premise offers a wide range of dynamic, purpose-driven career opportunities. We are currently looking for a Full Time Care Navigator Registered Nurse (RN) to join our team in San Antonio, TX.
PURPOSE OF THE POSITION
The Care Navigator, RN advocates for patients and their families by answering questions and/or resolves issues regarding care/benefit plans and health care management such as communicating patient concerns to appropriate staff, coordinating referrals through insurance and other physician offices or specialists, and educating patients about their diagnoses through the treatment process. The Care Navigator, RN also does health center outreach like planning lunch-and-learns, promoting onsite wellness programs, and developing marketing and communication plans.
ESSENTIAL JOB FUNCTIONS
- Serves as the subject matter expert for clients' benefits plan design and partners who utilize it
- Navigates the client's network and their providers and interprets information for patients and their families
- Ensures benefits program complies and is up-to-date with established policies, laws, and regulations
- Assists with health center communications relating to benefits
- Researches outstanding out-of-pocket expenses and resolves errors
- Resolves eligibility problems, incorrect claim charges, and claim denials
- Coordinates information flow of benefits between dental, medical, and other healthcare providers
- Assures correct application of specialist provider network status Care Coordination
- Fosters communications and coordinates benefits with insurance companies to create a smooth patient centered experience
- Health Advocacy (RN)
- Engenders a positive health center experience for all members
- Upholds patients' privacy and confidential information
- Informs patients and their families about available resources
- Communicates patients' questions, complaints, and concerns to appropriate staff
- Navigates the diagnostic evaluation with patients
- Answers questions about services that are condition specific or related to preventive care
- Educates patients and their families about their diagnoses through the treatment process
- Coordinates referrals through insurance and other physician offices or specialists
- Arrange for further medical treatment in collaboration with physicians and other Licensed Independent Practitioners
- Facilitates transferring medical records and lab results and reviewing results with another physician for diagnosis confirmation
- Schedules appointments and diagnostic tests
- Coordinates care for patients with complicated medical issues
- Directs telephone calls to appropriate personnel; initiatives triage slips for response by medical personnel
- May make follow-up telephone phone calls to patients
- Identifies emergency situations and provides care in accordance with rules and regulations
- Adheres to infection control protocols for a clean and safe environment
- Conducts health center outreach (eg lunch and learns)
- May coordinate and promote onsite wellness programs
- Assists development and implementing marketing and communication plans including promotional materials (eg displays, flyers, bulletin boards)
- Partners with health center staff to promote health and wellness programs
- Works with third party health and wellness vendors
- Represents the health center in scheduled or ad hoc employer meetings regarding health and wellness events or strategic initiatives
- Fosters positive patient/client professional relationships
- Develop understanding of Epic's referral and scheduling capabilities, and available tools
- Develop understanding of where member populations live and work, as well as high-value providers and facilities in key geographies
- Utilizes cost and quality tool(s) to identify high-value specialists and facilities in the community, and provides recommendations to members
- Proactively build relationships with community specialists, alongside other health center team members, to educate them on Premise and our expectations, facilitate streamlined referral access and information sharing
- Interact with Premise providers to understand referral needs
- Interact with members via multiple modalities (phone, email, in-person, video, etc.) to identify appropriate referral target(s)
- Work with community specialists and members to schedule appointments and ensure bi-directional notes transfer
- Follow-up with member post-specialist visit, ensure member and specialist notes return to Premise, and coordinate ongoing care needs as appropriate
- Remains in close coordination with Connected Care+ product team to leverage new tools and processes as the strategy evolves
BASIC QUALIFICATIONS
Education- Bachelor's degree or equivalent work experience
- Certificate from an accredited Nursing School or Associate degree (A.S.) required; Bachelor's degree (BSN) from four-year college or university preferred
- Currently licensed Registered Nurse in state of practice required
- Current Wellness Coach Certification from Wellcoaches OR equivalent International Coach Federation-accredited program certification (must be obtained within 24 months of hire)
- Current hands-on training in AHA or ARC Basic Life Support for health care providers required; Advanced Cardiac Life Support may also be required based on contract scope of services
- Certification in Occupational Health Nursing, Certification in Emergency Nursing, or Certificate in Case Management preferred
- Experience with benefit policies and/or programs and answering employees' benefits-related questions
- Experience with resolving conflicts or grievances; negotiating between parties
- 3+ years of non-clinical healthcare or wellness experience
- Epic experience preferred
- Referral experience preferred
- Knowledge of state and federal employment and employee benefit laws and regulations (eg RISA, COBRA, ACA, HIPAA, FMLA) and principles and practices of employee benefits and employee relations
- Knowledge of workplace health and safety concepts and OSHA regulations preferred
- Knowledge of principles and processes for providing customer and personal services
- Knowledge of computers and software programs to enter data and process information (eg inputting information into electronic health records)
- Ability to come up with unusual or clever ideas about a given topic or situation, or to develop creative ways to solve a problem
- Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person
- Analyzing information and evaluating results to choose the best solution and solve problems
- Developing constructive and cooperative working relationships with others, and maintaining them over time
- Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards
- Providing guidance and expert advice to management or other groups on technical, systems-, or process-related topics
- Translating or explaining what information means and how it can be used
- Developing specific goals and plans to prioritize, organize, and accomplish your work
- Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others
- Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form
- Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources' information can be exchanged in person, in writing, or by telephone or e-mail
- Knowledge of prior authorization processes and how to execute a prior authorization
Work-life balance is at the foundation of how decisions are made and where Premise is headed. We can only help people get, stay, and be well if we do the same for ourselves. In addition to competitive pay, Premise offers benefits packages including medical, dental, vision, life insurance, 401(k), paid holidays and vacation time, a company-sponsored wellness program, and much more our talent acquisition team will be happy to share with you.
Premise Health is an equal opportunity employer; we value inclusion, and we do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.
