Concierge Nurse Navigator - ME, NH or PA Resident

JOB SUMMARY: A Concierge Nurse Navigator is a professional registered nurse and a member of a team that shares the mission to improve health outcomes by building meaningful relationships. The primary responsibility of this team is to help members navigate today’s complex healthcare system. The RN in this role will be assisting members of Catholic Dioceses in the northeast region of the U.S. The Concierge Nurse Navigator empowers members to take an active role in their healthcare choices by educating them on the benefits of their health plan, sharing resources, and providing high-quality options for care. Our nurses primarily work from home, but occasionally have to travel to meet with clients. ESSENTIAL RESPONSIBILITIES:

• Educate members on the high-quality health care choices available to them
• Assist members in understanding their financial obligations for the healthcare decisions they have chosen based on their employer’s healthcare plan.
• Proactive outreach to at-risk members to assess their current state of health and determine future needs to improve long-term health.
• Function as a patient advocate
• Analyze and interpret hospital and provider quality data from multiple data sources
• Educate members on services and benefits of the Concierge Nurse Navigators program
• Chronic disease management outreach via phone, text or email
• Review high-cost medical and pharmacy claims to determine if outreach or intervention is appropriate
• Triage calls for a potential referral to a Center of Excellence or second opinion
• Assist with employee education during enrollment meeting or implementation of the Concierge Nurse Navigators program
• Work with the Clinical Program Manager to obtain a single case agreement (SCA) or Direct Contract when necessary
• Communicate waived member cost sharing to appropriate parties
• Document phone calls and inventions with members
• Educate members on the current health plan design and the optimization of provided benefits

JOB EXPECTATIONS:

• Uphold professional, caring, and compassionate communication to both clients and vendors
• Respond to client questions or concerns within 12-24 business hours
• Problem solve autonomously when appropriate
• Thorough documentation of interactions with vendors and clients
• Proficiency with Outlook, Excel, Word, Teams and PowerPoint

PHYSICAL REQUIREMENTS: This is a fast-paced setting that requires quick thinking and decision making. There will be intermittent periods of high stress. Involves standing, sitting, and extended periods of time on the phone and computer. EDUCATION, TRAINING, AND EXPERIENCE:

• Graduate of an Accredited School of Nursing required
• Current RN License required
• 5 + years as a clinically practicing nurse, case management, ICU or ER experience required
• Leadership skills demonstrated by increase of responsibilities such as working in the role of charge nurse, preceptor, administration, or participation in professional organizations or committees required.
• Excellent oral and written communication, collaborative and facilitative skills, customer service/relations focus organization skills required
• Microsoft office proficient preferred

NECESSARY SKILLS

• Critical thinking
• Autonomy
• Time management
• Basic Microsoft Excel, Word, and PowerPoint

PROTECTED HEALTH INFORMATION: Limits access to protected health information (PHI) to the information reasonably necessary to do the job. Shares information only on a need-to-know basis for work purposes. Access to verbal, written, and electronic PHI for this job has been determined based on job level and job responsibility within the organization. REPORTING RELATIONSHIPS: Clinical Program Manager Pay: $70,000.00 - $85,000.00 per year Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• Do you currently reside in the state of Maine, New Hampshire or Pennsylvania?

Experience:

• Nursing: 5 years (Required)

Language:

• Spanish (Preferred)

License/Certification:

• RN License (Required)

Willingness to travel:

• 25% (Required)

Work Location: Remote Apply tot his job Apply To this Job