Care Navigator - Utilization Management

P3 Health Partners•Omaha, NE

23d•Hybrid

About The Position

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. This position is responsible for assisting the nurses with Medical Management processes that do not require RN intervention, based on the scope of practice within the state. Through case finding, data and other tools, high risk patients will be identified and guided to enhance the achievement of the Quadruple Aim: improved outcomes, improved experience of care for patients and providers and lower healthcare costs.

Requirements

High School graduate required
Strong problem-solving skills required
Knowledge of medical terminology required
Excellent communication skills with patients, providers, internal and external customers required
Must have excellent computer skills
Must have excellent organizational skills and ability to work independently
Proficiency with computer, software programs (i.e. Microsoft Word, Excel) and internet required
Excellent communication and problem-solving skills
Excellent organizational and time management skills
Ability to learn quickly
Ability to handle a fast-paced environment and prioritize tasks based on importance
Strong interpersonal communication skills
Ability to work independently or as part of a team
Dedication to maintaining confidentiality of all patient records
Knowledge of medical terminology required
Ability to demonstrate knowledge of vital signs and other clinical skills to obtain and maintain employment
Familiarity with EMR’s

Nice To Haves

Education as a medical assistant or nursing school student helpful
Experience in a managed care organization preferred

Responsibilities

Promote the mission, vision and values of P3 Health Partners
Coordinates patient care activities between UM and CM for assigned patient populations
Provides administrative functions to support UM and CM
Makes initial follow up telephone call to patients discharged from a facility, acute or post-acute, unless acuity requires RN to perform
Provides outreach and guidance to non-high-risk patients
Responsible for managing ER utilization report and interventions, per policy, to address inappropriate ER utilization
Assists Medical Management team in gathering additional clinical information when applicable
Supports the Medical Management team with appropriate referrals, claims history or any other clinical information necessary
Responsible for timely and accurate documentation in systems
Develops spreadsheets and other tools to support Medical Management team
Assists patients in obtaining / coordinating community and other resources