Summary

The Health Navigator helps our members move through the healthcare system through educating members and their families about their diseases and treatments, translating medical jargon into readily accessible terms, and helping members navigate the healthcare system and processes and overcome any barriers to healthcare that they may face.

Essential Job Responsibilities

• Clinical Required: Provide patient care, treatment, and services within the scope of their license, certification or registration and as required by Federal and State laws and regulations.
• Support and navigate patients throughout the healthcare system
• Performs nursing assessments and triage of member care needs for new and ongoing members
• Central point of contact for all navigated members including interaction with medical, nursing, ancillary services, and pharmacy needs
• Provides education to members about their diagnoses, treatments, medications, overall health
• 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.
• Collect and report data from member on barriers, health care, medications, prior treatments, etc.
• Track order completion and follow up. Monitor member compliance with member treatment plan.
• Assist members with referrals to outside resources and care coordination as needed.
• Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives and safety, environmental, and/or infection control standards.
• Collaborates with medical providers, member care staff and clinic management in the planning and implementation of member and staff education.
• 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.
• 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.
• Provides care navigation services to insured members and their family:
  • Receives telephone calls or other inquiries from the employee or family, evaluates the current problem and develops a plan of care accordingly
  • 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
  • Provides oversight of chronic medical conditions
  • Research best practice, high quality care
  • Investigates costs associated with all aspects of care (procedures, labs, medications, surgeries, etc.)
  • Coordinates referrals as needed
  • Research 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
• Designs or participates in the creation of health education materials.
• Performs miscellaneous job-related duties as assigned.
• Reports clinically to the supervising physician in Employee Health.
• Embrace Diversity, Equity and Inclusion, by:

Treating everyone with dignity and respect

Opening more doors to opportunities for underrepresented cultures

Growing talent and people

Evaluating and eliminating disparities

Taking action against injustices, bias and racism

Honoring our differences and how to collaborate

Educating staff, patients and the communities we care for

Restoring Hope and Freedom, together

Essential Job Qualifications

• Licensure: Registered nurse in the state of Michigan.
• Education: Associates degree in nursing is required. Bachelor's degree preferred.
• Current Basic Life Support (BLS) certification
• Sound knowledge of the healthcare system and where to find reliable information.
• Excellent verbal and written communication skills.
• Excellent interpersonal skills
• Must be able to work effectively under time requirements and deadlines, problem-solve when facing unexpected issues, handle interruptions, and prioritize effectively.

Preferred Job Qualifications

• Prior experience in health navigation
• Experience with health insurance claims management

Physical Requirements for Essential Job Qualification

Levels:

• None (No specific requirements)
• Occasionally (Less than 1/3)
• Frequently (1/3 to 2/3)
• Majority (More than 2/3)

Remain in a stationary position: aMajoritya

Traverse or move around work location: aOccasionallya

Use keyboard: aFrequentlya

Operate or use department specific equipment: aNonea

Ascend/Descend equipment or ladder: aNonea

Position self to accomplish the Essential Functions of the role: aNonea

Receive and communicate information and ideas for understanding: aMajoritya

Transport, position, and/or exert force:

Up to 10 pounds: aOccasionallya

Up to 25 pounds: a _____a

Up to 50 pounds: a _____a

Up to 75 pounds: a _____a

More than 100 pounds: a _____a

Other weight: Up to___ pounds a _____a

Other: a _____a

The above statements are intended to describe the general nature and level of work being performed by employees in this classification. If you require a reasonable accommodation to perform the essential functions of this position, you must request accommodation in writing, within 182 days after you know or should know of the need for accommodation.

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.