RN Lead

3 weeks 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 expertise regarding CHRISTUS services. This position 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. The incumbent oversees the integrated data warehouse, including program utilization, disease management programs, and contracted provider network support.

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 analyzing 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.
  • Maintain consistent attendance, punctuality, and personal appearance in accordance with CHRISTUS attendance and dress code policies.
  • Uphold organizational values by treating others with respect, keeping commitments, and working ethically and with integrity.
  • Attend meetings as required and participate in team activities.
  • Establish and maintain effective working relationships with team members, patients, and the public.
  • Demonstrate the ability to read and respond to email and appointment requests in a timely manner.
  • Use time efficiently, plan for additional resources, set goals, and work in an organized manner.
  • Demonstrate safety practices and maintain a safe environment for patients, visitors, and fellow team members.

Requirements:
  • Associate's Degree in Nursing.
  • 5-7 years of experience.
  • RN License in the state of employment or compact.
  • BLS certification.

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