Nurse Navigator

3 days ago


Arlington Heights, Illinois, United States The Health Plan of West Virginia, Inc. Full time
Job Title: Nurse Navigator

We are seeking a skilled and compassionate Nurse Navigator to join our team at The Health Plan of West Virginia, Inc. As a key member of our clinical staff, you will play a vital role in ensuring our members receive high-quality, patient-centered care.

Responsibilities:
  • Conduct thorough admission, concurrent, and retrospective reviews of inpatient admissions and observation stays to determine medical necessity and appropriateness of care.
  • Collaborate with members, families, healthcare teams, and other stakeholders to coordinate care and services, identify needed medical services, and facilitate interventions to improve health outcomes.
  • Develop and implement personalized care plans, using specific assessment tools and revising them as needed, to ensure members receive timely and effective care.
  • Provide telephonic guidance and support to members, physicians, and other healthcare providers to facilitate the best options for meeting individual health care needs.
  • Identify and report potential high-cost cases to the reinsurance or stop-loss carrier through hospital review, referral requests, care or complex case navigation, or claims cost reports.
  • Utilize critical thinking skills to manage and evaluate member status and current treatment regimens against evidence-based guidelines.
  • Perform screenings and assessments of potential chronic disease navigation cases and demonstrate a working knowledge and adherence to contractual guidelines and policies of The Health Plan.
Requirements:
  • Registered Nurse with at least five (5) years of experience, with two (2) of those years in a clinical setting.
  • Active Ohio and WV licensure, with compliance with State Boards of Nursing continuing education policy.
  • Preferred critical care or other acute care experience.
  • Excellent oral, written, telephonic, and interpersonal skills, with the ability to balance independent and team working environments.
  • Flexibility and ability to multi-task, work in a fast-paced environment, and adapt to changing processes.
  • Superior work ethic and commitment to Excellence and Accountability.
Preferred Qualifications:
  • Utilization Management, Quality Improvement, Case Management, Disease Management, or other Managed Care experience.
  • Certification in area of clinical expertise related to current work, such as CDE, CCM, CMCN, Motivational Interviewing/MI Trainer, etc.
What We Offer:
  • A dynamic and supportive work environment.
  • Opportunities for professional growth and development.
  • A competitive salary and benefits package.

We are an equal opportunity employer and welcome applications from diverse candidates. If you are a motivated and compassionate healthcare professional looking for a challenging and rewarding role, please submit your application today.


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