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RN, Registered Nurse Patient Navigator Lead
2 months ago
Responsibilities:
* Oversee the development, implementation, and management of an integrated medical benefit program, including case management and health/disease management.
* Establish a system for coordinating the caseload patient's 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 that are determined to be targeted priorities by Senior Management of contracted employers.
* Interact with providers and plan members in case management medical activities to provide the most efficient and effective service.
* Identify targeted chronic diseases/high risk individuals (with vendor support) and develop programs to reduce the financial and health risks, using internal hospital programs/services whenever possible.
* Monitor and evaluate the effects of case management on the patient population.
* Create outcomes-management focus by interdisciplinary analysis of specific clinical, financial, and satisfaction elements for the patient population.
* Assist in the analysis of demographics, utilization, and reimbursement.
* Prepare cost analysis and other reports to determine the reasonableness of claim/cost data and utilization rates.
* Make recommendations based on data analysis for benefit structure, pharmacy formulary, deductibles, co-pays, out-of-pocket, etc. to contracted employer groups.
Requirements:
* Associate's Degree in Nursing
* 5 to 7 years of experience
* RN License in state of employment or compact
* BLS
We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and compassionate healthcare professional looking for a challenging and rewarding role, please apply today"}
