Patient Navigator Lead RN

2 weeks ago

San Antonio, 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 and expertise regarding CHRISTUS services. This role involves monitoring cases and claims, analyzing biometric and health risk assessment data, organizing disease management programs, and proactively interacting with members, physicians, and other providers.

Key Responsibilities
  • Develop, implement, and manage 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 in case management medical activities to provide efficient and effective service.
  • 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 by interdisciplinary analysis of clinical, financial, and satisfaction elements.
  • 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, and out-of-pocket expenses.
Requirements
  • Associate's Degree in Nursing
  • 5-7 years of experience as a Registered Nurse or Nurse Practitioner
  • RN License in the state of employment or compact
  • BLS certification

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