Healthcare Navigator

4 weeks ago


Phoenix, Arizona, United States Gallagher Full time

About the Role:

We are seeking a skilled Healthcare Navigator to join our team at Gallagher. As a Healthcare Navigator, you will play a critical role in ensuring the effective utilization of services and effective case/cost management. You will monitor and resolve escalated large claims issues, function as a liaison between referral source, physician and member, and coordinate appropriate cost-effective solutions.

Key Responsibilities:

  • Ensure appropriate utilization of services and effective case/cost management.
  • Monitor and resolve escalated large claims issues.
  • Function as a liaison between referral source, physician and member and coordinate appropriate cost-effective solutions.
  • Claim review to ensure appropriate treatment and billing.
  • Collect and analyze data related to health outcomes, program participation, and satisfaction to assess the effectiveness of wellness initiatives and make data-driven recommendations for improvement.
  • Identify members for referral opportunities to integrate with other services (i.e. Case Management, Disease Management).
  • Collaborate with healthcare professionals, vendors, and other departments or teams to integrate health and wellness initiatives.

Requirements:

  • Associate's degree from an accredited school of nursing.
  • Minimum of 3 years clinical experience in an acute care setting.
  • Active Registered Nursing license within the state of practice.

Preferred Qualifications:

  • BSN.
  • 3+ years clinical management experience.
  • Wellness/Health Coach experience.
  • 3+ year utilization management/case management experience in an insurance (non-hospital) setting.
  • 3+ years claims review experience including familiarity of reimbursement methodology.
  • Pre- and post-pay claims review and healthcare data experience preferred.
  • Experience in quality improvement related activities.
  • Knowledge of statistics, data collection, and survey design helpful.

About Gallagher:

Gallagher is a global insurance brokerage and risk management firm that is committed to providing innovative solutions to our clients. We believe in the importance of diversity and inclusion and are an equal opportunity employer.



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