Nurse Navigator

Gallagher•Phoenix, AZ

6h•Hybrid

About The Position

We are looking to add a Nurse Navigator to our growing team in Phoenix, AZ supporting our Kairos Division! As a nurse navigator, your role will be to guide and support our members in understanding their benefits and how best to utilize them. You will serve as a clinical concierge, providing healthcare navigation, proactive outreach, and assistance with claim resolution and prior authorization. Additionally, you will offer disease management and education, acting as a liaison between healthcare professionals, vendors, and other departments or teams. Your goal will be to ensure that our members receive the best possible care and support throughout their healthcare journey.

Requirements

Associate's degree from an accredited school of nursing
Minimum of 3 years clinical experience in an acute care setting
Active Registered Nursing license within the state of practice
Strong communication: ability to effectively communicate and present to groups and individuals
Critical thinking and problem-solving: assess health needs, identify risk factors, and develop appropriate interventions
Organizational and time management: manage multiple tasks and prioritize workload effectively
Flexibility and adaptability: ability to adjust approach and strategies based on the needs of individuals and groups
Collaboration and partnership: work effectively with other healthcare professionals, groups, and community organizations to deliver comprehensive wellness services
Professionalism and ethical conduct: adhere to ethical and legal standards in healthcare practice and maintain confidentiality
Continued learning and adaptability: willingness to learn and adapt to new software systems and technological advancements
Demonstrates adequate knowledge of managed care with emphasis on use of criteria , guidelines and national standards of practice
Demonstrates good written and oral communications, organizational and leadership skills
Computer literate
Demonstrates good time management skills
Self starter
Ability to travel locally to client sites 1-3x per month within Arizona

Nice To Haves

BSN
3+ year utilization management/case management experience in an insurance (non-hospital) setting
3+ years claims review experience including familiarity of reimbursement methodology
Pre- and post-pay claims review and healthcare data experience preferred
Experience in quality improvement related activities

Responsibilities

Ensures effective use of services and manages costs, helping control expenses and ensure fair practices
Review and analyze claims to understand resources that may be needed for resolution
Act as a liaison among referral sources, physicians, and members to facilitate cost-effective healthcare solutions and enhance communication
Collects and analyze data on health outcomes and program participation to assess and improve wellness initiatives, leading to better health outcomes and satisfaction
Identifies member for referral opportunities to integrate with other services, promoting comprehensive care
Collaborate with healthcare professionals, vendors, and departments to integrate health and wellness initiatives
Utilize understanding of case management, insurance plans, and regulations to ensure compliance and effective service delivery
Connect individuals with healthcare providers and community resources to address specific health needs, improving individual and community health outcomes

Benefits

Medical/dental/vision plans, which start from day one!
Life and accident insurance
401(K) and Roth options
Tax-advantaged accounts (HSA, FSA)
Educational expense reimbursement
Paid parental leave
Digital mental health services (Talkspace)
Flexible work hours (availability varies by office and job function)
Training programs
Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
Charitable matching gift program