Description
Summary: The Registered Nurse Patient Navigator Lead is a Registered Nurse or licensed Nurse Practitioner who provides health and wellness coaching, case management services, analysis and expertise regarding CHRISTUS services. These services will be provided by monitoring cases and claims, analyzing biometric and health risk assessment data, organizing disease management programs and proactively interacting with members, physicians and other providers. Incumbent oversees integrated data warehouse including program utilization, disease management programs and contracted provider network support.The CHRISTUS Children's Hospital, established in 1959, was the first children's hospital in South-Central Texas. Located downtown, this 190-plus-bed hospital serves more than 70,000 children annually from San Antonio, South Texas and around the world. The hospital (in partnership with Baylor College of Medicine) is the only academic children's hospital in San Antonio. Our highly specialized services meet the unique medical needs of children, from Pediatric and Neonatal Intensive Care to Children's Emergency Services, the latest treatments for deformities of the spine including titanium rib implants and halo traction, a Heart Center, a specialized asthma program, a highly regarded Cancer and Blood Disorders Center, and growing maternal services to include consultation, delivery, and maternal fetal medicine.
Responsibilities: - Oversee the development, implementation and management of an integrated medical benefit program including case management and health/disease management.
- Establish a system for coordinating the caseload patient's care throughout the continuum of care.
- Use standard tools, databases and methodologies to support the health benefit program and provide leadership in managing cases, events and diseases that are determined to be targeted priorities by Senior Management of contracted employers.
- Interact with providers and plan members in case management medical activities to provide the most efficient and effective service.
- Identify targeted chronic diseases/high risk individuals (with vendor support) and develop programs to reduce the financial and health risks, using internal hospital programs/services whenever possible.
- Monitor and evaluate the effects of case management on the patient population.
- Create outcomes-management focus by interdisciplinary analysis of specific clinical, financial and satisfaction elements for the patient population.
- Assist in the analysis of demographics, utilization and reimbursement.
- Prepare cost analysis and other reports to determine the reasonableness of claim/cost data and utilization rates.
- Make recommendations based on data analysis for benefit structure, pharmacy formulary, deductibles, co-pays, out of pocket, etc. to contracted employer groups.
- Maintain consistent attendance, punctuality and personal appearance in accordance with CHRISTUS attendance and dress code policies.
- Uphold organizational values by treating others with respect, keeping commitments and working ethically and with integrity.
- Attend meetings as required and participate in team activities. Exhibit confidence, motivate and inspire others.
- Establish and maintain effective working relationships with team members, patients and the public by demonstrating the ability to communicate verbally and in writing while responding clearly and effectively.
- Demonstrate the ability to read and respond to e-mail and appointment requests in a timely manner and on a regular basis.
- Use time efficiently, plan for additional resources, set goals and objectives and work in an organized manner.
- Demonstrate safety practices and maintain a safe environment for patients, visitors and fellow team members by following established safety and infection control standards.
Job Requirements: Education/Skills - Associate's Degree in Nursing
Experience- 5 to 7 years of experience
Licenses, Registrations, or Certifications - RN License in state of employment or compact
- BLS
Work Schedule: Varies
Work Type: Full Time
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