Nurse Navigator
4 weeks ago
We are seeking a skilled Nurse Navigator to join our team at The Health Plan of West Virginia Inc. As a key member of our care management team, you will play a vital role in ensuring our members receive high-quality, patient-centered care.
Key Responsibilities:
- Conduct thorough assessments of member needs and develop personalized care plans to address their unique health challenges.
- Collaborate with healthcare providers, members, and family members to coordinate care and services, ensuring seamless transitions and optimal health outcomes.
- Utilize clinical expertise to identify opportunities for improvement in care management processes and make recommendations to enhance the quality of care.
- Stay up-to-date on the latest clinical guidelines, research, and best practices in care management to ensure evidence-based decision-making.
- Develop and maintain strong relationships with healthcare providers, payers, and community resources to facilitate access to care and services.
- Participate in quality improvement initiatives to drive continuous improvement in care management processes and outcomes.
Requirements:
- Registered Nurse with at least 5 years of experience in a clinical setting.
- Active licensure in Ohio and West Virginia, with the ability to maintain licensure throughout employment.
- Excellent communication, interpersonal, and problem-solving skills.
- Ability to work in a fast-paced environment and adapt to changing priorities and processes.
- Proficient in electronic health records and other relevant software systems.
Preferred Qualifications:
- Experience in care management, utilization review, or case management.
- Knowledge of managed care principles, policies, and procedures.
- Certification in a relevant clinical specialty, such as case management or utilization review.
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Inpatient Navigator
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Nurse Inpatient Navigator
2 months ago
Wheeling, United States The Health Plan of West Virginia, Inc. Full timeResponsible to conduct systematic admission, concurrent, and retrospective hospital reviews for severity of illness and length of stay, to manage an inpatient admission, and to implement discharge planning and make discharge survey calls as required with pertinent clinical information and mandatory data with intervention and follow-up as identified using...
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