Health Navigator - RN

Mary Free Bed Rehabilitation Hospital•Grand Rapids, MI

1d•Onsite

About The Position

The Health Navigator helps our members move through the healthcare system through 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.

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.
Reports clinically to the supervising physician in Employee Health.
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.
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.
Contribute by identifying problems and seeking solutions.
Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.