Health Navigator - RN

Mary Free Bed Rehabilitation Hospital • Grand Rapids, MI

10h • Onsite

About The Position

The Health Navigator helps our members move through the healthcare system by 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 processes and overcome any barriers to healthcare that they may face. This role involves providing patient care, treatment, and services within the scope of their license, certification, or registration and as required by Federal and State laws and regulations. The Health Navigator acts as a central point of contact for navigated members, interacting with medical, nursing, ancillary services, and pharmacy needs. They provide education on diagnoses, treatments, medications, and overall health, guiding members through their healthcare journey, simplifying complexities, and acting as a liaison with providers, insurance companies, health systems, and suppliers to maximize cost, quality, and satisfaction. The role also includes collecting and reporting data, tracking order completion, monitoring treatment plan compliance, and assisting with referrals to outside resources and care coordination. The Health Navigator follows established policies, procedures, and quality improvement objectives, and functions as an advocate while maintaining confidentiality. They educate members, families, and the healthcare delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, and case management to facilitate informed decisions. The role promotes member self-advocacy, choice, and self-determination, and educates members and their families regarding the appropriate use of healthcare services to improve quality of care and maintain cost-effectiveness. The Health Navigator receives telephone calls or other inquiries, evaluates problems, and develops plans of care, collaborating with third-party administrators and external service providers. They assist with accessing the appropriate level of care, follow up post-access to evaluate outcomes, provide oversight of chronic medical conditions, research best practices and high-quality care, investigate costs associated with care, coordinate referrals, and research health concerns. The Health Navigator empowers members through information and support to make informed decisions and communicates with members to promote participation in the development and execution of the plan of care. They may also design or participate in the creation of health education materials and perform miscellaneous job-related duties as assigned. Clinically, the role reports to the supervising physician in Employee Health.

Requirements

• Registered nurse in the state of Michigan.
• Associates degree in nursing is required.
• 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.

Nice To Haves

• Bachelor’s degree preferred.
• Prior experience in health navigation
• Experience with health insurance claims management

Responsibilities

• 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.
• Support 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 members including interaction with medical, nursing, ancillary services , and pharmacy needs
• Provides education to members 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 satisfaction.
• 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 members 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.
• Demonstrate excellent customer service and standards of behaviors as well as encourages, coaches, and monitors the same in team members.
• Consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information .
• Contribute by identifying problems and seeking solutions.
• Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.

Benefits

• Treating everyone with dignity and respect.
• Opening more doors to opportunity for others to succeed.
• Growing talent and people.
• Ensuring a welcoming experience for all we serve, regardless of origin, race, religion, disability, sexual orientation or socioeconomic status.
• Taking action against discrimination .
• Honoring our differences and how we collaborate.
• Educating staff, patients and the communities we care for.
• Restoring hope and freedom, together.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree