Health Navigator - RN

About this role

Summary  

​ ​ The   H ealth   N avigator   helps   our employees mov e   through the healthcare system   through   educating   staff 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 ​    

Tra

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