Case Manager/Clinical Financial Navigator - Oncology

Trinity Health • Grove City, OH

5d • Onsite

About The Position

In accordance with the Mission, Core Values and Vision; the clinical financial navigator assesses financial needs for new and established patients to reduce financial barriers by utilizing insurance optimization opportunities as well as external assistance programs. Has an elevated level of understanding of health care diagnoses, and how to optimize this knowledge to help patients with health insurance coverage and benefits. Incorporates clinical knowledge of the patient’s diagnosis, treatment regimen and treatment goals, to find the best insurance and assistance programs available. Finds ways to help patients decrease their out-of-pocket expenses and assuring payment for treatment provided.

Requirements

• Masters degree in clinical health field (preferable nursing or social work).
• Maintains licensure in the state of Ohio for their clinical field (nursing, social work)
• 7 years of combine applicable clinical experience in a health care setting, as well as health insurance and financial experience.
• Effective Communication Skills
• Knowledge of clinical settings and overall disease processes and understanding how this clinical knowledge is critical to help patients with insurance optimization and decreasing financial barriers.
• Knowledge of insurance optimization and copay assistance programs.
• High level of initiative and ability to self-direct to solve financial barriers, as well as the ability to work collaboratively with the treatment team.

Nice To Haves

• Clinical knowledge of specific disease processes within the setting of hire (i.e. oncology).
• Experience with insurance optimization, Patient Assistance Programs, Co-Pay Assistance Programs, Medicaid, Medicare Safety Net Programs, Medicare health plans, the Marketplace and COBRA guidelines.

Responsibilities

• Exhibits each of the Mount Carmel Service Excellence Behavior Standards holding self and others accountable and role modeling excellence for all to see. For example: demonstrates friendliness and courtesy, effective communication creates a professional environment and provides first class service.
• Meets population specific and all other competencies according to department requirements.
• Promotes a Culture of Safety by adhering to policy, procedures and plans that are in place to prevent workplace injury, violence or adverse outcome to associates and patients.
• Relationship-based Care: Creates a caring and healing environment that keeps the patient and family at the center of care throughout their experience at Mount Carmel following the principles of our interdisciplinary care delivery system. (For patient care providers) Provides nursing care, ensures an environment of patient safety, promotes evidence-based practice and quality initiatives, and exhibits professionalism in nursing practice within the model of the ANCC Magnet Recognition Program®.
• Assess financial needs for all cancer patients as well as all outpatient infusion patients, which includes, but not limited to, reviewing current insurance, disease state, and treatment regimen.
• Understands clinical disease state and treatment regimens for specific disease processes patients are undergoing, as a result is able provide optimal insurance optimization and copay assistant programs.
• Proactively anticipates pending financial toxicity for patients, through clinical knowledge and insurance/copay assistance knowledge.
• Proactively educates patients regarding insurance optimization opportunities to decrease financial burdens/toxicity and assure payment for treatment provided.
• Educates qualifying patients regarding available external assistance programs when needed.
• Exhibits excellent customer service skill and passion for access to care and decreasing financial toxicity.
• Maintains strong, working relationships with other members of the treatment team (i.e. physicians, social workers, nurse navigators, etc.)
• Participate in activities to enhance professional development.
• Reports quarterly data: saving and/or recovery of payment generated in this role
• Functions as a subject matter expert to the Financial Navigation Team
• Demonstrates extensive knowledge of the Revenue Cycle Process.
• Is a member of the Cancer Service line Revenue Cycle Committee and actively responsible for collecting data regarding their savings to patients and the organization.
• Will present information at meetings with senior leadership.

Benefits

• Competitive compensation
• Day one benefit packages including medical, dental and vision coverage.
• Retirement saving account with employer match starting on day one
• Generous paid time off programs
• Employee recognition incentive program.
• Tuition and professional development reimbursement – fully discounted tuition through our enrollment opportunities at the Mount Carmel College of Nursing.
• Flexible schedules through our FirstChoice Internal Travel Program, Weekend Option Program, and local Float Pool.
• DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 251-500 employees