Memorial Hermann is where you belong.
Health Solutions Nurse Navigator
At Memorial Hermann, we’re about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.
Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.
Job SummaryThis role calls for a nurse who is passionate about wellness, enjoys working independently and is a self-starter. Memorial Hermann is partnering with an onsite employer located in the West Houston area in support of enhancing the health of their employee population. The nurse navigator role fills a vital need in patient advocacy, giving each patient under their care a consistent point of connection to navigate their healthcare journey. Candidates with a nursing, population health, case management and nurse navigator experience are strongly encouraged to apply. The role will require regular onsite visits to the client’s location, primarily in the North, Northwest, West Houston and Sealy regions. Position will meet with employees in one-on-one and group settings to support them in their health journey.
Responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating options and services required to meet an individual’s health and wellness needs using communication and available resources to promote quality, cost-effective outcomes.
• Educating the patient about their disease and treatment options
• Offering emotional support
• Helping to manage side effects
• Linking patients with community resources that may help them stay on track with treatment or improve their quality of life
• Assisting in communication with doctors and acting as a liaison
• Offering aid in setting up appointments, etc.
• Ensuring translation services are available to non-native speakers
• Providing basic nutritional advice
Education: Graduate of an accredited school of nursing (Associates of Nursing or Bachelors of Nursing )
Licenses/Certifications: Current, unrestricted Texas licensure to practice as a Registered Nurse required; CCM certification preferred
Experience / Knowledge / Skills
- Three (3) to five (5) years clinical experience, three (3) to five (5) years experience in a Managed Care environment performing case management
- Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement
- Strong clinical background in nursing or social services
- Knowledge of insurance terminology
- Basic knowledge of computer system
- Excellent verbal and written communication skills
- Ability to perform multiple tasks simultaneously, works under pressure, and meet critical deadlines
- Assertiveness and negotiation skills, which support ability to interact with hospital, discharge planner, physicians and other health care providers
- Exceptional documentation skills
- Ability to work independently, manage time and prioritize projects
- Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.
- Demonstrates commitment to Health Solutions behavioral expectations in all interactions and in performing all job duties. Perform job duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety and cost efficiency
- Analyzes referrals to accept or deny individuals according to Case Management procedures.
- Serves as a means for facilitating patient wellness and autonomy though advocacy, communication, education, and identification of service resources.
- Helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost effective manner in order to obtain optimal value for both the patient and the client.
- Establish/maintain good rapport with provider to obtain necessary information.
- Follows Health Solutions guidelines and procedures to make appropriate referrals relative to individual cases (Physician Review, Stop Loss, etc.).
- Presents all cases when unable to negotiate an acceptable alternative to the Medical Director for determination.
- Collects accurate data for system input by using correct coding of diagnoses and/or procedures.
- Enters data into appropriate system and prepare all written communication to patient and/or provider.
- Adheres to and apply all Health Solutions policies, procedures, and guidelines appropriately.
- Achieves an in-depth knowledge of client benefit plan.
- Acts as resource person for Utilization Review staff.
- Performs other related duties as requested by Supervisor/Director.
- Processes and maintain confidential information according to confidentiality policy.
- Negotiates fees with non contracted providers and refer to contracting.
- Maintains a 90% or greater score on the quarterly audit tool.
- Communicate, collaborate and cooperate with internal and external stakeholders.
- Adheres to all Compliance/Program Integrity requirements.
- Complies with HIPAA Regulations
- Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
- Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
- Other duties as assigned.
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