Job id :Â 6546-3701
Essential Job Responsibilities
- Provides care navigation services to insured employees, spouses and their family members:
- Completes an initial assessment of current and past health history (physical, mental and psychosocial health) for each insured member
- Determines individualâs health risk
- Implements the members plan of care to lessen and/or avoid worsening health risk
- Determines potential future needs and develops a plan to address those needs
- Receives telephone calls or other inquiries from the member, triage, and collaborates with the nurse navigator to determine most appropriate plan of care
- 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
- Investigates costs associated with all aspects of care (procedures, labs, medications, surgeries, etc.)
- Coordinates referrals as needed
- Researches 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.
- 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
- 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.
- Provides Health Coaching as needed
- 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.
- Documents member health status, progress toward goals, outcomes and navigation touch points through an electronic medical record.
- Participates in orientation and training of new staff
- Supervises staff and student internships as appropriate
- Participates in program enhancement and service recovery as needed
- Supports program operations as assigned
- Other duties as assigned.
Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.
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