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Patient Care Navigator

1 month ago


Wheeling, West Virginia, United States The Health Plan Full time

Job Summary

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We are seeking a highly skilled Patient Care Navigator - Clinical Services to join our team at The Health Plan. As a key member of our clinical services department, you will be responsible for navigating complex patient care pathways and ensuring seamless transitions between providers.

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About the Role

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In this critical role, you will work closely with patients, families, and healthcare teams to assess, plan, implement, coordinate, monitor, and evaluate patient care plans. Your expertise will help identify opportunities for improvement in systems, processes, functions, programs, procedures, and make recommendations to enhance the effectiveness of medical management services.

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Key Responsibilities

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  • Clinical Review: Conduct thorough reviews of inpatient admissions and observation stays, determining appropriateness of admission and continued stay using established clinical criteria.">
  • Care Coordination: Collaborate with patients, families, healthcare teams, hospital utilization review, social workers, and other resources to intervene proactively and identify needed medical services, utilization, and discharge issues.">
  • Quality Improvement: Identify potential quality issues, variances, hospital-acquired conditions, and never events, referring to the QI Department for further action.">
  • Tech Evaluation: Review and evaluate relevant information, including member history, medical records, group contracts, benefit design, plan limitations, exclusions, coordination of benefits, and member eligibility, making decisions and recommendations consistent with sound medical and managed care practice.">
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Requirements

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  • Education: Registered Nurse (RN) degree required; BSN preferred.">
  • Experience: At least 5 years of experience in a clinical setting, with a minimum of 2 years in a similar role; critical care or acute care experience preferred.">
  • Licensure: Active Ohio and WV licensure required; must maintain throughout employment.">
  • Skills: Excellent oral, written, telephonic, and interpersonal skills; proficiency in keyboarding and computer literacy; ability to navigate multiple systems.">
  • Certification: Certification in area of clinical expertise related to current work (e.g., CDE, CCM, CMCN, Motivational Interviewing/MI Trainer).">
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Compensation

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The estimated salary range for this position is $85,000 - $110,000 per annum, depending on qualifications and experience. This figure includes annual performance-based bonuses and benefits packages offered by The Health Plan.

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Benefits

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We offer an attractive benefits package, including comprehensive health insurance, retirement savings plan, paid time off, and professional development opportunities. Our employees enjoy a dynamic and supportive work environment that fosters collaboration, innovation, and continuous learning.

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Additional Information

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As a Patient Care Navigator - Clinical Services, you will play a vital role in shaping the future of healthcare at The Health Plan. If you are passionate about delivering high-quality patient care and contributing to the success of our organization, we encourage you to apply for this exciting opportunity.