RN, Senior Patient Navigator

1 week ago

Longview, Texas, United States CHRISTUS Health Full time

Job Summary:

The Registered Nurse Patient Navigator Lead is a key member of the CHRISTUS Health team, responsible for providing health and wellness coaching, case management services, and analysis expertise to support the health plan of employers contracting with CHRISTUS for chronic disease and high-risk case management/population health management services.

This role involves monitoring cases and claims, analyzing biometric and health risk assessment data, organizing disease management programs, and proactively interacting with plan members, physicians, and other providers to ensure seamless care coordination throughout the continuum of care.

The incumbent oversees the integrated data warehouse for support of the health benefit program, including program utilization, disease management programs, and contracted provider network support.

Key Responsibilities:

  • Develop, implement, and manage an integrated medical benefit program, including case management and health/disease management services.
  • Establish a system for coordinating patient care throughout the continuum of care, ensuring effective communication and collaboration with healthcare providers.
  • Utilize standard tools, databases, and methodologies to support the health benefit program and provide leadership in managing cases, events, and diseases that are targeted priorities by Senior Management of contracted employers.
  • 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, leveraging internal hospital programs/services whenever possible.
  • Monitor and evaluate the effects of case management on the patient population, analyzing clinical, financial, and satisfaction elements.
  • Assist in the analysis of demographics, utilization, and reimbursement for the health plan, preparing 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, out-of-pocket expenses, and other program elements to contracted employer groups.
  • Maintain consistent attendance, punctuality, and personal appearance in accordance with CHRISTUS Health 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, demonstrating confidence, motivating, and inspiring others.
  • Establish and maintain effective working relationships with team members, patients, and the public by demonstrating the ability to communicate verbally and in writing while responding clearly and effectively.
  • Use time efficiently, plan for additional resources, set goals and objectives, and work in an organized manner.
  • Demonstrate safety practices and maintain a safe environment for patients, visitors, and fellow team members by following established safety and infection control standards.

Requirements:

  • Associate's Degree in Nursing
  • 3 to 5 years of experience in case management or a related field
  • RN License in the state of employment or compact
  • BLS certification

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