Patient Care Navigator

7 days ago


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

Overview

The Health Plan of West Virginia Inc is seeking a skilled Patient Care Navigator to join our team. As a key member of our healthcare team, you will play a vital role in ensuring that patients receive the highest quality care.

Salary

$65,000 - $85,000 per year, depending on experience.

About the Job

This position requires a Registered Nurse with at least 5 years of experience, preferably in critical care or other acute care settings. You will be responsible for conducting telephonic and/or on-site admission reviews, coordinating care with members, families, healthcare teams, and other resources.

Key Responsibilities

  • Conducts systematic reviews of patient admissions and stays to determine medical necessity and appropriateness of care.
  • Collaborates with patients, families, and healthcare teams to develop personalized care plans and coordinate services.
  • Identifies potential high-cost cases and reports them to the reinsurance or stop-loss carrier as needed.
  • Provides education and support to patients and providers to facilitate informed decision-making and optimal health outcomes.
  • Participates in quality improvement activities to achieve program outcomes and improve patient care.

Requirements

  • Active Ohio and WV licensure, which must be maintained throughout employment.
  • Excellent oral, written, telephonic, and interpersonal communication skills.
  • Flexibility and ability to multitask in a fast-paced environment.
  • Superior work ethic and commitment to excellence and accountability.
  • Able to exercise independent and sound judgment in decision-making.

About Us

The Health Plan of West Virginia Inc is a leading provider of healthcare services in the region. We are committed to delivering high-quality care and improving the lives of our members. If you are a motivated and compassionate healthcare professional who shares our vision, we encourage you to apply for this exciting opportunity.



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