Nurse Navigator

Welcome! We’re excited you’re considering an opportunity with us!

This position collaborates with patients and primary care providers to ensure patients receive quality, efficient, and cost-effective healthcare services. Responsible for triaging incoming patient calls, assessing needs, giving appropriate clinical dispositions and facilitating referrals. This position will educate the patient when appropriate regarding immediate care advice and preventative behaviors.

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• Current unencumbered licensure with the WV Board of Registered Professional Nurses, or appropriate state board where services will be provided, as a registered professional nurse OR current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
• Obtain certification in Basic Life Support within 30 days of hire date.

EXPERIENCE:

• Three (3) years of nursing experience.

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• Bachelor of Science in Nursing (BSN).

EXPERIENCE:

• Preferred prior care coordination experience.
• Five (5) years of nursing experience.

• Professional assessment of callers needs using established criteria and protocols while performing accurate, concise and timely documentation.
• Use established software, online resources, written materials and nursing background to provide callers with appropriate medical information.
• Identifies problems or gaps in care offering opportunity for intervention.
• Facilitates referrals within our clinics by scheduling and coordinating either a clinic appointment, e-visit or telehealth visit with a provider.
• Supports consumers in selection of best physician and facility to maximize access, quality, and manage healthcare cost.
• Provides health education and coaches consumers on treatment alternatives to assist them in best- decision making.
• Identifies the nature and urgency of patient’s healthcare needs and determine appropriate disposition via telephone.
• Documents all conversations with patients with patients to maintain a comprehensive medical record.
• Supports team environment which allows clear communication, positive support and creative thinking.
• Communicates with Case management, Community Health Workers, patients, families, and physicians/providers to assist in safe transition of care.
• Ambulatory Utilization Management, Financial management and Quality Screening for assigned patients.
• Identifies the targeted population and risk stratifies patients to prioritize needs and direct interventions.
• Works collaboratively with patients to design an individualized plan of care that ensures coordination of services by the healthcare team.
• Clinical performance improvement, outcome management and quality activities.
• Uses data to drive decisions and plan/implement performance improvement strategies for assigned patients, including fiscal, clinical and patient satisfaction data.
• Implements clinical interventions based on risk stratification and evidence based clinical guideline adherence and promotes best practice by initiating/adjusting therapies as directed by the practitioner and providing appropriate follow-up monitoring as needed.
• Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency results for assigned population.
• Monitors clinical and financial indicators on an ongoing basis and takes action to achieve continuous improvement in both areas.
• Works with leadership to continuously evaluate process, identify problems, and propose process improvement strategies.
• Educates multidisciplinary team and physicians about clinical pathways/protocols and managed care principles.

• Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping are necessary body movements utilized in performing duties through the work shift.
• Ability to sit for long periods of time.

• Office/call center setting environment.

• Must be flexible in fast past and rapidly changing environment.
• Excellent oral and written communication skills, as well as motivated and…