RN Patient Navigator Lead

2 months ago

San Antonio, Texas, United States Christus Health Full time
Job Summary

The Registered Nurse Patient Navigator Lead is a key role within CHRISTUS Health, responsible for providing health and wellness coaching, case management services, and analysis to support CHRISTUS services. This position plays a critical role in 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.
  • Utilize 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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