Health Navigator - RN

Health Navigator - RN

Summary

The H ealth N avigator helps our members mov e through the healthcare system through educating members and their families about their diseases and treatments, translating medical jargon into readily accessible terms, and helping members navigate the healthcare system and process es and overcome any barriers to healthcare that they may face.

Essential Job Responsibilities

• Clinical Required : Provide patient care, treatment, and services within the scope of their license, certification or registration and as required by Federal and State laws and regulations.

• Suppor t and navigate patients throughout the healthcare system

• Performs nursing assessments and triage of member care needs for new and ongoing members

• Central point of contact for all navigated member s including interaction with medical, nursing, ancillary services , and pharmacy needs

• Provides education to member s about their diagnoses, treatments, medications, overall health

• Guides members through their health care journey, simplifying the labyrinth of health care while being a liaison with providers, insurance companies, health systems and supplier of health care to maximize cost, quality and satisfactio n.

• Collect and report data from member on barriers, health care, medications, prior treatments, etc.

• Track order completion and follow up. Monitor member compliance with member treatment plan.

• Assist member s with referrals to outside resources and care coordination as needed.

• Follows established departmental policies, procedures, and objectives , continuous quality improvement objectives and safety, environmental, and/or infection control standards.

• Collaborates with medical providers, member care staff and clinic management in the planning and implementation of member and staff education.

• Functions as an advocate and maintains confidentiality. Educate the member , the family, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, case management, etc., so that timely and informed decisions can be made .

• Promote member self-advocacy, choice, and self-determination. Educate members and their families regarding the appropriate use of health care services. Improve quality of care and maintain cost effectiveness on a case-by-case basis.

• Provides care navigation services to insured members and their family:

• Receives telephone calls or other inquiries from the employee or family, evaluates the current problem and develops a plan of care accordingly

• Collaborates with third party administrator (TPA) and other external service providers

• Assists with accessing appropriate level of care

• Follows up post access to care to evaluate outcomes

• Provides oversight of chronic medical conditions

• Research best practice, high quality care

• Investigates costs associated with all aspects of care (procedures, labs, medications, surgeries, etc.)

• Coordinates referrals as needed

• Research information on health concerns

• Advocates for the most appropriate care at the most appropriate time

• Empowers members through information and support to make informed decisions

• Communicate with members to promote participation in the development and execution of the plan of care

• Designs or participates in the creation of health education materials.

• Performs miscellaneous job-related duties as assigned.

• Reports clinically to the supervising physician in E mployee H ealth.

• We’ll embrace all people by:

T reating everyone with dignity and respect.

O pening more doors to opportunity for others to succeed.

G rowing talent and people.

E nsuring a welcoming experience for all we serve, regardless of origin, race, religion, disability, sexual orientation or socioeconomic status.

T aking action against discrimination .

H onoring our differences and how we collaborate.

E ducating staff, patients and the communities we care for.

R estoring hope and freedom, together.

Customer Service Responsibilities

Demonstrate excellent customer service and standards of behaviors as well as encourages, coaches, and monitors the same in team members. This individual should consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information .

Responsibilities in Quality Improvement

Contribute by identifying problems and seeking solutions. Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.

Essential Job Qualifications

• Licensure: Registered nurse in the state of Michigan.

• Education: Associates degree in nursing is required . Bachelor’s degree preferred.

• Current Basic Life Support (BLS) certification

• Sound knowledge of the healthcare system and where to find reliable information.

• Excellent verbal and written communication skills.

• Excellent interpersonal skills

• Must be able to work effectively under time requirements and deadlines, problem-solve when facing unexpected issues, handle interruptions, and prioritize effectively.

Preferred Job Qualifications

• Prior experience in health navigation

• Experience with health insuranc e claims management
  
  

Physical Requirements for Essential Job Qualification

Levels :

• None (No specific requirements)

• Occasionally (Less than 1/3)

• Frequently (1/3 to 2/3)

• Majority (More than 2/3)
  
  

Remain in a stationary position: Majority

Traverse or move around work location: Occasionally

Use keyboard: Frequently

Operate or use department specific equipment: None

Ascend/Descend equipment or ladder: None

Position self to accomplish the Essential Functions of the role: None

Receive and communicate information and ideas for understanding: Majority

Transport, position, and/or exert force:

Up to 10 pounds: Occasionally

Up to 25 pounds: _____

Up to 50 pounds: _____

Up to 75 pounds: _____

More than 100 pounds: _____

Other weight: Up to___ pounds _____

Other: _____

Consistent with the Americans with Disabilities Act (ADA), it is the policy of Mary Free Bed Rehabilitation Hospital to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Talent Acquisition team at [email protected] .

Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic .