RN Navigator Lead

4 days ago


Hill Country Village, Texas, United States CHRISTUS Health Full time
Job Summary

The Registered Nurse Patient Navigator Lead is a key member of our healthcare team, responsible for providing health and wellness coaching, case management services, and analysis to support CHRISTUS services. This role involves monitoring cases and claims, analyzing biometric and health risk assessment data, and organizing disease management programs to proactively interact with members, physicians, and other providers.

Key Responsibilities
  • Develop and implement an integrated medical benefit program, including case management and health/disease management.
  • Establish a system for coordinating patient care throughout the continuum of care.
  • Use standard tools, databases, and methodologies to support the health benefit program and provide leadership in managing cases, events, and diseases.
  • Interact with providers and plan members to provide efficient and effective case management services.
  • Identify targeted chronic diseases/high-risk individuals and develop programs to reduce financial and health risks.
  • Monitor and evaluate the effects of case management on the patient population.
  • Create outcomes-management focus through interdisciplinary analysis of clinical, financial, and satisfaction elements.
  • Assist in analyzing demographics, utilization, and reimbursement.
  • Prepare cost analysis and reports to determine claim/cost data and utilization rates.
  • Make recommendations based on data analysis for benefit structure, pharmacy formulary, deductibles, co-pays, and out-of-pocket expenses.
Requirements
  • Associate's Degree in Nursing
  • 5-7 years of experience
  • RN License in state of employment or compact
  • BLS

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