RN Medical Management Services

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. 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.

Requirements : Education / Skills ~ Associate's Degree in Nursing

Experience ~3 to 5 years of experience Licenses, Registrations, or

Certifications RN License in state of employment or compact BLS

Work Schedu le : 5 Days - 8 Hours Work Type : Full Time