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Senior RN Patient Navigator

2 months 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, analysis, and expertise for the health plans of employers contracting with CHRISTUS for chronic disease and high-risk case management/population health management services.

Key Responsibilities:
  • Program Development and Management: Oversee the development, implementation, and management of an integrated medical benefit program, including case management and health/disease management.
  • Care Coordination: Establish a system for coordinating the caseload patient's care throughout the continuum of care.
  • Case Management: Use standard tools, databases, and methodologies to support the health benefit program and provide leadership in managing cases, events, and diseases that are determined to be targeted priorities by Senior Management of contracted employers.
  • Provider and Member Interaction: Interact with providers and plan members in case management medical activities to provide the most efficient and effective service.
  • Chronic Disease Management: Identify targeted chronic diseases/high-risk individuals (with vendor support) and develop programs to reduce the financial and health risks, using internal hospital programs/services whenever possible.
  • Outcomes Management: Monitor and evaluate the effects of case management on the patient population.
  • Interdisciplinary Analysis: Create outcomes-management focus by interdisciplinary analysis of specific clinical, financial, and satisfaction elements for the patient population.
  • Cost Analysis: Assist in the analysis of demographics, utilization, and reimbursement for the health plan.
  • Reporting and Recommendations: 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, out-of-pocket, etc. to contracted employer groups.
  • Professional Development: Maintain consistent attendance, punctuality, and personal appearance in accordance with CHRISTUS attendance and dress code policies.
  • Team Collaboration: 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. Exhibit confidence, motivate, and inspire others.
  • Communication: 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.
  • Time Management: Use time efficiently, plan for additional resources, set goals, and objectives, and work in an organized manner.
  • Safety and Infection Control: Demonstrate safety practices and maintain a safe environment for patients, visitors, and fellow team members by following established safety and infection control standards.