Care Navigator RN
Apply NowCompany: Premise Health
Location: San Antonio, TX 78228
Description:
Healthcare Without Rival
Premise Health is the world's leading direct healthcare provider and one of the largest digital providers in the country, serving over 11 million eligible lives across more than 2,500 of the largest commercial and municipal employers in the U.S. Premise partners with its clients to offer fully connected care - in-person and in the digital environment. It operates more than 800 onsite and nearsite wellness centers in 45 states and Guam, delivering care through the Digital Wellness Center and onsite, nearsite, mobile, and event solutions.
Premise delivers value by simplifying complexity and breaking down barriers to give diverse member populations access to convenient, integrated, high-quality care. We offer more than 30 products, delivering the breadth and depth of care required to serve organizations' total populations. The result is healthcare that meets the needs of members and their families, helping them live healthier while lowering costs for organizations.
Premise offers a wide range of dynamic, purpose-driven career opportunities. We are currently looking for a Full Time Care Navigator Registered Nurse (RN) to join our team in San Antonio, TX.
PURPOSE OF THE POSITION
The Care Navigator, RN advocates for patients and their families by answering questions and/or resolves issues regarding care/benefit plans and health care management such as communicating patient concerns to appropriate staff, coordinating referrals through insurance and other physician offices or specialists, and educating patients about their diagnoses through the treatment process. The Care Navigator, RN also does health center outreach like planning lunch-and-learns, promoting onsite wellness programs, and developing marketing and communication plans.
ESSENTIAL JOB FUNCTIONS
Serves as the subject matter expert for clients' benefits plan design and partners who utilize it
Navigates the client's network and their providers and interprets information for patients and their families
Ensures benefits program complies and is up-to-date with established policies, laws, and regulations
Assists with health center communications relating to benefits
Researches outstanding out-of-pocket expenses and resolves errors
Resolves eligibility problems, incorrect claim charges, and claim denials
Coordinates information flow of benefits between dental, medical, and other healthcare providers
Assures correct application of specialist provider network status Care Coordination
Fosters communications and coordinates benefits with insurance companies to create a smooth patient centered experience
Health Advocacy (RN)
Engenders a positive health center experience for all members
Upholds patients' privacy and confidential information
Informs patients and their families about available resources
Communicates patients' questions, complaints, and concerns to appropriate staff
Navigates the diagnostic evaluation with patients
Answers questions about services that are condition specific or related to preventive care
Educates patients and their families about their diagnoses through the treatment process
Coordinates referrals through insurance and other physician offices or specialists
Arrange for further medical treatment in collaboration with physicians and other Licensed Independent Practitioners
Facilitates transferring medical records and lab results and reviewing results with another physician for diagnosis confirmation
Schedules appointments and diagnostic tests
Coordinates care for patients with complicated medical issues
Directs telephone calls to appropriate personnel; initiatives triage slips for response by medical personnel
May make follow-up telephone phone calls to patients
Identifies emergency situations and provides care in accordance with rules and regulations
Adheres to infection control protocols for a clean and safe environment
Conducts health center outreach (e.g. lunch and learns)
May coordinate and promote onsite wellness programs
Assists development and implementing marketing and communication plans including promotional materials (e.g. displays, flyers, bulletin boards)
Partners with health center staff to promote health and wellness programs
Works with third party health and wellness vendors
Represents the health center in scheduled or ad hoc employer meetings regarding health and wellness events or strategic initiatives
Fosters positive patient/client professional relationships
Develop understanding of Epic's referral and scheduling capabilities, and available tools
Develop understanding of where member populations live and work, as well as high-value providers and facilities in key geographies
Utilizes cost and quality tool(s) to identify high-value specialists and facilities in the community, and provides recommendations to members
Proactively build relationships with community specialists, alongside other health center team members, to educate them on Premise and our expectations, facilitate streamlined referral access and information sharing
Interact with Premise providers to understand referral needs
Interact with members via multiple modalities (phone, email, in-person, video, etc.) to identify appropriate referral target(s)
Work with community specialists and members to schedule appointments and ensure bi-directional notes transfer
Follow-up with member post-specialist visit, ensure member and specialist notes return to Premise, and coordinate ongoing care needs as appropriate
Remains in close coordination with Connected Care+ product team to leverage new tools and processes as the strategy evolves
BASIC QUALIFICATIONS
Education:
Bachelor's degree or equivalent work experience
Certificate from an accredited Nursing School or Associate degree (A.S.) required; Bachelor's degree (BSN) from four-year college or university preferred
Currently licensed Registered Nurse in state of practice required
Current Wellness Coach Certification from Wellcoaches OR equivalent International Coach Federation-accredited program certification (must be obtained within 24 months of hire)
Current hands-on training in AHA or ARC Basic Life Support for health care providers required; Advanced Cardiac Life Support may also be required based on contract scope of services
Certification in Occupational Health Nursing, Certification in Emergency Nursing, or Certificate in Case Management preferred
Experience:
Experience with benefit policies and/or programs and answering employees' benefits-related questions
Experience with resolving conflicts or grievances; negotiating between parties
3+ years of non-clinical healthcare or wellness experience
Epic experience preferred
Referral experience preferred
Knowledge and Skills:
Knowledge of state and federal employment and employee benefit laws and regulations (e.g. RISA, COBRA, ACA, HIPAA, FMLA) and principles and practices of employee benefits and employee relations
Knowledge of workplace health and safety concepts and OSHA regulations preferred
Knowledge of principles and processes for providing customer and personal services
Knowledge of computers and software programs to enter data and process information (e.g. inputting information into electronic health records)
Ability to come up with unusual or clever ideas about a given topic or situation, or to develop creative ways to solve a problem
Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person
Analyzing information and evaluating results to choose the best solution and solve problems
Developing constructive and cooperative working relationships with others, and maintaining them over time
Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards
Providing guidance and expert advice to management or other groups on technical, systems-, or process-related topics
Translating or explaining what information means and how it can be used
Developing specific goals and plans to prioritize, organize, and accomplish your work
Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others
Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form
Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources' information can be exchanged in person, in writing, or by telephone or e-mail
Knowledge of prior authorization processes and how to execute a prior authorization
Work-life balance is at the foundation of how decisions are made and where Premise is headed. We can only help people get, stay, and be well if we do the same for ourselves. In addition to competitive pay, Premise offers benefits packages including medical, dental, vision, life insurance, 401(k), paid holidays and vacation time, a company-sponsored wellness program, and much more our talent acquisition team will be happy to share with you.
Premise Health is an equal opportunity employer; we value inclusion, and we do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.
Premise Health is the world's leading direct healthcare provider and one of the largest digital providers in the country, serving over 11 million eligible lives across more than 2,500 of the largest commercial and municipal employers in the U.S. Premise partners with its clients to offer fully connected care - in-person and in the digital environment. It operates more than 800 onsite and nearsite wellness centers in 45 states and Guam, delivering care through the Digital Wellness Center and onsite, nearsite, mobile, and event solutions.
Premise delivers value by simplifying complexity and breaking down barriers to give diverse member populations access to convenient, integrated, high-quality care. We offer more than 30 products, delivering the breadth and depth of care required to serve organizations' total populations. The result is healthcare that meets the needs of members and their families, helping them live healthier while lowering costs for organizations.
Premise offers a wide range of dynamic, purpose-driven career opportunities. We are currently looking for a Full Time Care Navigator Registered Nurse (RN) to join our team in San Antonio, TX.
PURPOSE OF THE POSITION
The Care Navigator, RN advocates for patients and their families by answering questions and/or resolves issues regarding care/benefit plans and health care management such as communicating patient concerns to appropriate staff, coordinating referrals through insurance and other physician offices or specialists, and educating patients about their diagnoses through the treatment process. The Care Navigator, RN also does health center outreach like planning lunch-and-learns, promoting onsite wellness programs, and developing marketing and communication plans.
ESSENTIAL JOB FUNCTIONS
Serves as the subject matter expert for clients' benefits plan design and partners who utilize it
Navigates the client's network and their providers and interprets information for patients and their families
Ensures benefits program complies and is up-to-date with established policies, laws, and regulations
Assists with health center communications relating to benefits
Researches outstanding out-of-pocket expenses and resolves errors
Resolves eligibility problems, incorrect claim charges, and claim denials
Coordinates information flow of benefits between dental, medical, and other healthcare providers
Assures correct application of specialist provider network status Care Coordination
Fosters communications and coordinates benefits with insurance companies to create a smooth patient centered experience
Health Advocacy (RN)
Engenders a positive health center experience for all members
Upholds patients' privacy and confidential information
Informs patients and their families about available resources
Communicates patients' questions, complaints, and concerns to appropriate staff
Navigates the diagnostic evaluation with patients
Answers questions about services that are condition specific or related to preventive care
Educates patients and their families about their diagnoses through the treatment process
Coordinates referrals through insurance and other physician offices or specialists
Arrange for further medical treatment in collaboration with physicians and other Licensed Independent Practitioners
Facilitates transferring medical records and lab results and reviewing results with another physician for diagnosis confirmation
Schedules appointments and diagnostic tests
Coordinates care for patients with complicated medical issues
Directs telephone calls to appropriate personnel; initiatives triage slips for response by medical personnel
May make follow-up telephone phone calls to patients
Identifies emergency situations and provides care in accordance with rules and regulations
Adheres to infection control protocols for a clean and safe environment
Conducts health center outreach (e.g. lunch and learns)
May coordinate and promote onsite wellness programs
Assists development and implementing marketing and communication plans including promotional materials (e.g. displays, flyers, bulletin boards)
Partners with health center staff to promote health and wellness programs
Works with third party health and wellness vendors
Represents the health center in scheduled or ad hoc employer meetings regarding health and wellness events or strategic initiatives
Fosters positive patient/client professional relationships
Develop understanding of Epic's referral and scheduling capabilities, and available tools
Develop understanding of where member populations live and work, as well as high-value providers and facilities in key geographies
Utilizes cost and quality tool(s) to identify high-value specialists and facilities in the community, and provides recommendations to members
Proactively build relationships with community specialists, alongside other health center team members, to educate them on Premise and our expectations, facilitate streamlined referral access and information sharing
Interact with Premise providers to understand referral needs
Interact with members via multiple modalities (phone, email, in-person, video, etc.) to identify appropriate referral target(s)
Work with community specialists and members to schedule appointments and ensure bi-directional notes transfer
Follow-up with member post-specialist visit, ensure member and specialist notes return to Premise, and coordinate ongoing care needs as appropriate
Remains in close coordination with Connected Care+ product team to leverage new tools and processes as the strategy evolves
BASIC QUALIFICATIONS
Education:
Bachelor's degree or equivalent work experience
Certificate from an accredited Nursing School or Associate degree (A.S.) required; Bachelor's degree (BSN) from four-year college or university preferred
Currently licensed Registered Nurse in state of practice required
Current Wellness Coach Certification from Wellcoaches OR equivalent International Coach Federation-accredited program certification (must be obtained within 24 months of hire)
Current hands-on training in AHA or ARC Basic Life Support for health care providers required; Advanced Cardiac Life Support may also be required based on contract scope of services
Certification in Occupational Health Nursing, Certification in Emergency Nursing, or Certificate in Case Management preferred
Experience:
Experience with benefit policies and/or programs and answering employees' benefits-related questions
Experience with resolving conflicts or grievances; negotiating between parties
3+ years of non-clinical healthcare or wellness experience
Epic experience preferred
Referral experience preferred
Knowledge and Skills:
Knowledge of state and federal employment and employee benefit laws and regulations (e.g. RISA, COBRA, ACA, HIPAA, FMLA) and principles and practices of employee benefits and employee relations
Knowledge of workplace health and safety concepts and OSHA regulations preferred
Knowledge of principles and processes for providing customer and personal services
Knowledge of computers and software programs to enter data and process information (e.g. inputting information into electronic health records)
Ability to come up with unusual or clever ideas about a given topic or situation, or to develop creative ways to solve a problem
Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person
Analyzing information and evaluating results to choose the best solution and solve problems
Developing constructive and cooperative working relationships with others, and maintaining them over time
Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards
Providing guidance and expert advice to management or other groups on technical, systems-, or process-related topics
Translating or explaining what information means and how it can be used
Developing specific goals and plans to prioritize, organize, and accomplish your work
Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others
Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form
Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources' information can be exchanged in person, in writing, or by telephone or e-mail
Knowledge of prior authorization processes and how to execute a prior authorization
Work-life balance is at the foundation of how decisions are made and where Premise is headed. We can only help people get, stay, and be well if we do the same for ourselves. In addition to competitive pay, Premise offers benefits packages including medical, dental, vision, life insurance, 401(k), paid holidays and vacation time, a company-sponsored wellness program, and much more our talent acquisition team will be happy to share with you.
Premise Health is an equal opportunity employer; we value inclusion, and we do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.