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Bilingual Health Insurance Navigator
✦ New
$28.80 - 38.30
Join Us in Shaping the Future of Health Care
At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team.
What's in it for you:
- Growth opportunities to uplevel your career
- A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
- Competitive compensation and comprehensive benefits focused on well-being
- An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.
You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities.
Qualifications you'll bring:
- Two or more years in a customer service or sales environment, with some experience in the health care industry such as a hospital, medical office, or health insurance company.
- The ability to speak more than one language (for example, English and Spanish).
- An Associate's degree or equivalent combination of education and related experience.
- The availability to work full-time, hybrid, including local travel weekdays, nights and weekend for events.
- Must have a valid driver's license.
- Curiosity to foster innovation and pave the way for growth.
- Humility to play as a team.
- Commitment to being the difference for our customers in every interaction.
Your key responsibilities:
- Spearhead our membership growth initiatives in crucial target areas by identifying eligible individuals and seamlessly enrolling them in a variety of plans including Medicaid, Child Health Plus, Essential Plan, Qualified Health Plans (QHPs), HARP, Off-Exchange, Medicare Advantage (MA) products, and Dual Eligible Special Needs Plans (D-SNP).
- Conduct both individual and group outreach activities to present our innovative health care solutions on- and off-site at various events-from health fairs and community expos to festivals and holiday-themed gatherings-ensuring MVP's presence is both seen and felt. Your collaborative efforts alongside our Field Marketing and Community Engagement Representatives will be pivotal in driving growth and visibility in assigned territories.
- Foster positive relationships with community-based organizations, medical provider partners, and community contacts to develop a robust network within your territory.
- Navigate the local landscape with required travel , embracing the opportunity to bring MVP's customer-centric philosophy to life across our footprint.
- Participate in necessary screenings and provide proof of immunization as part of our commitment to community well-being.
- Demonstrate the dynamic capability to transport up to 30 lbs. of promotional materials, which play a key role in educating and empowering our customers about their health care choices.
- Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing health care delivery and being the difference for the customer.
Where you'll be:
- Remote with local travel in Dutchess or Orange Counties. (This opportunity includes salary, travel reimbursement and incentives)
Pay Transparency
MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.
We do not request current or historical salary information from candidates.
$28.80-$38.30
MVP's Inclusion Statement
At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.
MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.
To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at .
permanent
S
LAB Pathology Navigator
✦ New
Salary not disclosed
Primary City/State:
Phoenix, Arizona
Department Name:
Support Ops Admin-Ref Lab
Work Shift:
Day
Job Category:
Lab
Find your Voice, Passion, & Purpose
POSITION SUMMARY
This position serves as a liaison between pathologists, clinical care teams, and reference laboratories to ensure a seamless and efficient care from diagnosis to treatment and participates in the coordination and navigation of complex molecular, esoteric, and pathology-related testing, including clinical trial referrals and multidisciplinary planning. This position is part of a centralized system support team responsible for managing pathology consults, test send outs, and data tracking related to molecular testing and plays a critical role in ensuring appropriate tissue handling, test utilization, and billing processes are followed. While these standards are intended to be an accurate reflection of the job requirements, management reserves the right to modify add/or remove duties and to assign other duties as necessary.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.
CORE FUNCTIONS
1. Acts as a centralized resource for the Banner sites and promotes cross-departmental collaboration to support standardized, efficient workflows for pathology and molecular testing, while positively promoting the Mission, Vision and Values of the company and supporting the Road Map.
2. Coordinates triage of pathology specimens and molecular test requests communicates with the clinical care team to gather pertinent clinical history, pathology reports, and progress notes as well as supports the organization and facilitation of multidisciplinary tumor boards and planning conferences.
3. Sends specimens to designated reference laboratories for molecular and esoteric testing and tracks testing status and reports results to appropriate care teams in a timely manner. Enters and manages molecular and pathology data to support research, quality initiatives, reporting requirements, and appropriate billing practices.
4. Serves as a resource, communicating courteously, effectively, and accurately with internal and external customers to include molecular testing vendors. Interacts with peers and coworkers with an emphasis on teamwork and a strong focus on customer service excellence. Functions as a liaison between and partners with other departments, as necessary.
5. Works closely with pathology, histology and referral laboratories to ensure best utilization of tissues to ensure it is prepared appropriately for requested testing. Mentors staff and helps develop policies.
NOTE: The core functions are intended to describe the general content and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by leadership.
MINIMUM QUALIFICATIONS
High school diploma or equivalent.
Five (5) years of experience in pathology, laboratory services, molecular testing coordination, or related clinical setting.
Proficient in Microsoft Office Suite and laboratory information systems (LIS).
Must possess a valid driver's license.
PREFERRED QUALIFICATIONS
Project Management experience, with knowledge or application of Lean and Six Sigma methodologies.
Direct experience with multi-site operations and system-level responsibilities. Strong organizational, analytical, and communication skills.
Knowledge of regulatory and billing practices related to molecular testing.
Bachelor's degree in business, health care administration or related field.
Additional related education and/or experience.
EEO Statement:
EEO/Disabled/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy
Phoenix, Arizona
Department Name:
Support Ops Admin-Ref Lab
Work Shift:
Day
Job Category:
Lab
Find your Voice, Passion, & Purpose
POSITION SUMMARY
This position serves as a liaison between pathologists, clinical care teams, and reference laboratories to ensure a seamless and efficient care from diagnosis to treatment and participates in the coordination and navigation of complex molecular, esoteric, and pathology-related testing, including clinical trial referrals and multidisciplinary planning. This position is part of a centralized system support team responsible for managing pathology consults, test send outs, and data tracking related to molecular testing and plays a critical role in ensuring appropriate tissue handling, test utilization, and billing processes are followed. While these standards are intended to be an accurate reflection of the job requirements, management reserves the right to modify add/or remove duties and to assign other duties as necessary.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.
CORE FUNCTIONS
1. Acts as a centralized resource for the Banner sites and promotes cross-departmental collaboration to support standardized, efficient workflows for pathology and molecular testing, while positively promoting the Mission, Vision and Values of the company and supporting the Road Map.
2. Coordinates triage of pathology specimens and molecular test requests communicates with the clinical care team to gather pertinent clinical history, pathology reports, and progress notes as well as supports the organization and facilitation of multidisciplinary tumor boards and planning conferences.
3. Sends specimens to designated reference laboratories for molecular and esoteric testing and tracks testing status and reports results to appropriate care teams in a timely manner. Enters and manages molecular and pathology data to support research, quality initiatives, reporting requirements, and appropriate billing practices.
4. Serves as a resource, communicating courteously, effectively, and accurately with internal and external customers to include molecular testing vendors. Interacts with peers and coworkers with an emphasis on teamwork and a strong focus on customer service excellence. Functions as a liaison between and partners with other departments, as necessary.
5. Works closely with pathology, histology and referral laboratories to ensure best utilization of tissues to ensure it is prepared appropriately for requested testing. Mentors staff and helps develop policies.
NOTE: The core functions are intended to describe the general content and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by leadership.
MINIMUM QUALIFICATIONS
High school diploma or equivalent.
Five (5) years of experience in pathology, laboratory services, molecular testing coordination, or related clinical setting.
Proficient in Microsoft Office Suite and laboratory information systems (LIS).
Must possess a valid driver's license.
PREFERRED QUALIFICATIONS
Project Management experience, with knowledge or application of Lean and Six Sigma methodologies.
Direct experience with multi-site operations and system-level responsibilities. Strong organizational, analytical, and communication skills.
Knowledge of regulatory and billing practices related to molecular testing.
Bachelor's degree in business, health care administration or related field.
Additional related education and/or experience.
EEO Statement:
EEO/Disabled/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy
Not Specified
Surgical Specialty Navigator - Operating Room - Full Time
🏢 Guthrie
Salary not disclosed
Position Summary:
Under the guidance of the Nurse Manager, the Surgical Specialty Navigator (SSN) is responsible for the surgical care of patients; supervision of assigned personnel; orientation and teaching of new employees to their specialty and ongoing in‐service programs. SSC keeps the nursing manager informed of all activities of assigned services; seeks guidance as needed; supports the nursing manager in carrying out unit objective and is a primary representative of the nursing manager. Streamlining the care between the Guthrie Clinic, Preadmission Services, the Preparation Recovery Unit, the Operating Room, and the patient care units. Facilitation of an atmosphere of interactive management and the development of collegial relationships among surgical personnel and other team members is critical.
Education, License & Cert:
Graduate from an accredited Licensed Practical Nursing program or graduated from an accredited School of Surgical Technology. Knowledge of procedures and techniques involved in administering medical treatments and related patient care. Surgical Technicians that have been grandfathered from previous years of experience will be considered.
AS Associate of Science • AST Associate Surgical technology
Experience:
A minimum of two years clinical experience and demonstrated abilities in surgical technology. Operating room experience preferred; may be trained on the job if recent graduate; must have general knowledge of surgical procedures and draw specialized training from working with a physician or physician group. Must be able to travel to other Guthrie Clinic offices in New York and Pennsylvania and participate with “on‐call” schedule.
Essential Functions:
Clinical Practice‐ Participates in establishing standards of care in area of expertise and in evaluating surgical care against these standards utilizing conceptual frameworks and theory as a basis for clinical practice. Education/Staff Development ‐ Assists in the assessment, maintenance, and development of staff competencies as necessary or requested. Assists in coordinating the educational programs including preparation of preceptors, goal‐setting, and on‐going evaluation. Supports the philosophy and objectives of the organization ‐ Serves as a member of the leadership team and promotes organizational values and departmental vision and goals; demonstrates the ability to be a person of influence when relating to our patients, family, staff, physicians and all other customers; provides leadership for promoting safe, effective patient care, according to best practices; creates a work environment that enhances both employee and patient satisfaction and encourages professional growth of staff and identifies growth and development opportunities with employees, and challenges employees to achieve their maximum potential; promotes communication between the surgeon and the staff members to assure patient needs are met. Regulatory Requirements / Performance Improvement ‐ Demonstrates and enforces compliance with hospital, State, and Federal guidelines. Focuses on performance improvement. Personal and professional development ‐ Pursues professional development through Guthrie Learn Leadership Modules and the surgical technician clinical ladder Participates in process/performance improvement activities ‐ Maintains collaborative relationships with all members of the health care team to maximize care and patient outcomes; is assigned activities in the hospital/unit performance improvement and participates in the planning and presentation of educational programs.
Other Duties:
Maintain accuracy of preference lists for surgeon(s) in their service area(s). Assist OR staff / company reps as needed / required during scheduled working day. It is understood that this description is not intended to be all‐inclusive, and that other duties may be assigned as necessary in the performance of this position. Participate in cycle/yearly inventory management counts. Partner with the Operating Room Inventory Control Manager / FIT / PAM committees to achieve cost containment per case and not compromise patient care or safety Collaborate with the surgeon(s) / staff to establish capital item requests and prepare and present requests per capital request guidelines. Collaborate with the Operating Room Inventory Control Manager regarding special requests and assures the availability of items prior to the procedure time. Collaborate with the surgeon(s) to obtain approval / develop protocol for new surgical procedures. Assists manager in preparation of department budget. Reviews service specific financial statements monthly, i.e., waste statements, repairs, etc. Works toward standardization of supplies / equipment within their service(s).
Payrate: $26.25 to $38.50
Under the guidance of the Nurse Manager, the Surgical Specialty Navigator (SSN) is responsible for the surgical care of patients; supervision of assigned personnel; orientation and teaching of new employees to their specialty and ongoing in‐service programs. SSC keeps the nursing manager informed of all activities of assigned services; seeks guidance as needed; supports the nursing manager in carrying out unit objective and is a primary representative of the nursing manager. Streamlining the care between the Guthrie Clinic, Preadmission Services, the Preparation Recovery Unit, the Operating Room, and the patient care units. Facilitation of an atmosphere of interactive management and the development of collegial relationships among surgical personnel and other team members is critical.
Education, License & Cert:
Graduate from an accredited Licensed Practical Nursing program or graduated from an accredited School of Surgical Technology. Knowledge of procedures and techniques involved in administering medical treatments and related patient care. Surgical Technicians that have been grandfathered from previous years of experience will be considered.
AS Associate of Science • AST Associate Surgical technology
Experience:
A minimum of two years clinical experience and demonstrated abilities in surgical technology. Operating room experience preferred; may be trained on the job if recent graduate; must have general knowledge of surgical procedures and draw specialized training from working with a physician or physician group. Must be able to travel to other Guthrie Clinic offices in New York and Pennsylvania and participate with “on‐call” schedule.
Essential Functions:
Clinical Practice‐ Participates in establishing standards of care in area of expertise and in evaluating surgical care against these standards utilizing conceptual frameworks and theory as a basis for clinical practice. Education/Staff Development ‐ Assists in the assessment, maintenance, and development of staff competencies as necessary or requested. Assists in coordinating the educational programs including preparation of preceptors, goal‐setting, and on‐going evaluation. Supports the philosophy and objectives of the organization ‐ Serves as a member of the leadership team and promotes organizational values and departmental vision and goals; demonstrates the ability to be a person of influence when relating to our patients, family, staff, physicians and all other customers; provides leadership for promoting safe, effective patient care, according to best practices; creates a work environment that enhances both employee and patient satisfaction and encourages professional growth of staff and identifies growth and development opportunities with employees, and challenges employees to achieve their maximum potential; promotes communication between the surgeon and the staff members to assure patient needs are met. Regulatory Requirements / Performance Improvement ‐ Demonstrates and enforces compliance with hospital, State, and Federal guidelines. Focuses on performance improvement. Personal and professional development ‐ Pursues professional development through Guthrie Learn Leadership Modules and the surgical technician clinical ladder Participates in process/performance improvement activities ‐ Maintains collaborative relationships with all members of the health care team to maximize care and patient outcomes; is assigned activities in the hospital/unit performance improvement and participates in the planning and presentation of educational programs.
Other Duties:
Maintain accuracy of preference lists for surgeon(s) in their service area(s). Assist OR staff / company reps as needed / required during scheduled working day. It is understood that this description is not intended to be all‐inclusive, and that other duties may be assigned as necessary in the performance of this position. Participate in cycle/yearly inventory management counts. Partner with the Operating Room Inventory Control Manager / FIT / PAM committees to achieve cost containment per case and not compromise patient care or safety Collaborate with the surgeon(s) / staff to establish capital item requests and prepare and present requests per capital request guidelines. Collaborate with the Operating Room Inventory Control Manager regarding special requests and assures the availability of items prior to the procedure time. Collaborate with the surgeon(s) to obtain approval / develop protocol for new surgical procedures. Assists manager in preparation of department budget. Reviews service specific financial statements monthly, i.e., waste statements, repairs, etc. Works toward standardization of supplies / equipment within their service(s).
Payrate: $26.25 to $38.50
permanent
Pediatric Cardiovascular Surgery RN Navigator
Salary not disclosed
Your future role at a glance
Location: Austin, TX
Facility: Dell Children's Medical Center
Department/Specialty: Cardiology Services
Schedule: Monday - Friday | 4 10-hour shifts, rotating days | 7:00 am - 5:00 pm
Life at Ascension: Where purpose meets opportunityAscension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter.
Benefits that help you thrive- Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options
- Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance
- Time to recharge: pro-rated paid time off (PTO) and holidays
- Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning
- Emotional well-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources
- Family support: parental leave, adoption assistance and family benefits
- Other benefits: optional legal and pet insurance, transportation savings and more
Benefit options and eligibility vary by position, scheduled hours and location. Benefits are subject to change at any time. Your recruiter will provide the most up-to-date details during the hiring process.
How you’ll make an impact in this role- Clinical Excellence & Care Delivery: Deliver high-quality direct nursing care by adhering to organizational protocols while implementing and monitoring customized patient care plans.
- Interdisciplinary Care Coordination: Act as the primary coordinator across all medical disciplines to ensure seamless, well-coordinated patient care and timely execution of physician orders.
- Patient Advocacy & Monitoring: Champion patient safety through continuous surveillance, recording, and communication of condition changes to the healthcare team.
- Strategic Discharge Planning: Lead the assessment and coordination of complex discharge needs, collaborating with inter-professional teams to ensure safe and successful transitions from hospital to home.
Licensure / Certification / Registration:
- BLS Provider obtained within 1 Month (30 days) of hire date or job transfer date required. American Heart Association or American Red Cross accepted.
- Registered Nurse credentialed from the Texas Board of Nursing obtained prior to hire date or job transfer date required.
Education:
- Diploma from an accredited school/college of nursing OR professional licensure at time of hire required.
- Must be a Registered Nurse
- BSN is preferred
- Congenital Heart experience strongly desired
Equal employment opportunity employer
Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.
Fraud prevention notice
Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.
E-Verify statement
Employer does not participate in E-Verify and therefore cannot employ STEM OPT candidates.
Not Specified
Healthcare Navigation Nurse (SEGUIN)
Salary not disclosed
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
National certification (e.g.
CCRN, RNC, CEN, CNOR, OCN, ANCC, CAN, CPAN, CFRN, etc.) in related field is preferred.
Three years recent, full-time hospital experience preferred.
Work experience in case management, utilization review or hospital quality assurance experience is preferred.
Must complete a Clinical Documentation Improvement Course within specified time of hire date.
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required.
National certification in related field is preferred.
Case Manager Certification (CCM or ANCC) is highly desirable.
Not Specified
Patient Placement Navigator (BOERNE)
🏢 University Health
Salary not disclosed
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred.
National certification (e.g.
CCRN, RNC, CEN, CNOR, OCN, ANCC, CAN, CPAN, CFRN, etc.) in related field is preferred.
Three years recent, full-time hospital experience preferred.
Work experience in case management, utilization review or hospital quality assurance experience is preferred.
Must complete a Clinical Documentation Improvement Course within specified time of hire date.
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required.
National certification in related field is preferred.
Case Manager Certification (CCM or ANCC) is highly desirable.
placement student
Patient Care Navigator (SAN ANTONIO)
✦ New 🏢 University Health
Salary not disclosed
POSITION SUMMARY/RESPONSIBILITIES
The nurse case manager coordinates, in collaboration with the patient and interdisciplinary team, the treatment/ plan of care for a patient within the acute episode of care. He/she proactively facilitates interventions to assure timely delivery of services, evaluates the effectiveness of interventions, tracks variances and/or barriers in the plan of care, and functions as the patient advocate to identify and communicate health care needs.
EDUCATION/EXPERIENCE
Bachelor's degree in Nursing is highly preferred. Three to five years nursing experience required. Work experience in case management, utilization review or hospital quality is preferred.
LICENSURE/ CERTIFICATIONS
Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred. Current American Heart Association, Basic Cardiac Life Support and/or Health Care Provider card preferred.
Not Specified
Healthcare Navigator (PLEASANTON)
🏢 University Health
Salary not disclosed
POSITION SUMMARY/RESPONSIBILITIES
Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
Care Coordinator will be instrumental in assisting the department and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare managed group to enhance financial outcomes. Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the patient advocate to identify and communicate health care needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to improve patient outcomes, compliance, and decrease complications.
EDUCATION/EXPERIENCE
Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review, or hospital quality assurance experience is preferred.
LICENSURE/CERTIFICATION
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse Educator certification is highly desirable. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
permanent
Health Plan Nurse Navigator (PLEASANTON)
🏢 University Health
Salary not disclosed
POSITION SUMMARY/RESPONSIBILITIES
Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of resources, cost and quality of health care for members; coordinating care between the primary care physician, community resources, family and member; coordinating care across the health care continuum while monitoring and managing benefit utilization; and, collaborating with multi-disciplinary health care team members in identifying the educational and discharge needs of members.
EDUCATION/EXPERIENCE
Registered Nurse (RN) is required. Bachelor of Science in Nursing (BSN) or Master’s degree is preferred. Minimum three (3) years nursing, acute care, quality management or managed care experience is required. Basic knowledge of Medicaid, Medicare, community resources and alternate funding programs is desired. Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred.
LICENSURE/CERTIFICATION
Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. Current certification from an appropriate professional agency, such as Case Management Society, is preferred.
Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of resources, cost and quality of health care for members; coordinating care between the primary care physician, community resources, family and member; coordinating care across the health care continuum while monitoring and managing benefit utilization; and, collaborating with multi-disciplinary health care team members in identifying the educational and discharge needs of members.
EDUCATION/EXPERIENCE
Registered Nurse (RN) is required. Bachelor of Science in Nursing (BSN) or Master’s degree is preferred. Minimum three (3) years nursing, acute care, quality management or managed care experience is required. Basic knowledge of Medicaid, Medicare, community resources and alternate funding programs is desired. Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred.
LICENSURE/CERTIFICATION
Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. Current certification from an appropriate professional agency, such as Case Management Society, is preferred.
permanent
Patient Care Navigator RN (BOERNE)
🏢 University Health
Salary not disclosed
POSITION SUMMARY/RESPONSIBILITIES
Functions as an integral member of the physician-led care team that provides primary care including preventive care and on-going health maintenance for selected groups of patients. Participates in the care of well, acutely ill and chronically ill patients.
EDUCATION
BSN is required. Recent patient care experience in transplant or at least one year of experience as a registered nurse is required. National certification in transplant is preferred.
LICENSURE/CERTIFICATION
Must be currently licensed as a Registered Nurse in the State of Texas. Must maintain current AHA BLS or higher. ACLS preferred.
Functions as an integral member of the physician-led care team that provides primary care including preventive care and on-going health maintenance for selected groups of patients. Participates in the care of well, acutely ill and chronically ill patients.
EDUCATION
BSN is required. Recent patient care experience in transplant or at least one year of experience as a registered nurse is required. National certification in transplant is preferred.
LICENSURE/CERTIFICATION
Must be currently licensed as a Registered Nurse in the State of Texas. Must maintain current AHA BLS or higher. ACLS preferred.
permanent
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