RN Nurse Navigator - Care Connect

Company :

Job Description : 

GENERAL OVERVIEW:

This job consists of working in high-volume, fast paced call center environment in which nurse assists  all callers- such as referring physicians, patients, caregivers, families, and the community with coordination of patient services through clinical triage and scheduling. Facilitates patient flow, including coordination of appointments and assists the patient with accessing clinical and supportive care services within the Network. This job coordinates focused aspects of care in collaboration with the multidisciplinary team for adult/Pediatric patients to ensure they receive quality and comprehensive services. Identifies caller needs and provides education, screening, support, referrals, coordination of care, and any other assistance identified as necessary.

ESSENTIAL RESPONSIBILITIES

• Serves as preliminary contact for AHN patients by: Greeting patients via telephone in a pleasant and professional manner, Prioritizing patient inquiries, Ensuring that accurate demographic and payor information is correctly reflected in the billing system, Maintaining positive customer service attitude when dealing with the public and AHN personnel, Working effectively as a team member by offering support and/or ideas to enable the group to reach group goals. (25%)
• In a call center setting, provides professional nursing assessments, prioritizes treatments according to the urgency of need, and collaborates with other departments to appropriately coordinate patient services.(20%)
• Assist non-clinical staff with clinical issues and questions. (20%)
• Coordinates appointments including aspects of the multi-disciplinary team (physicians, consults, supportive care services, etc.). (10%)
• Works with AHN physician offices/facilities to identify at-risk patients and assists in facilitating appropriate screening processes. (10%)
• Work inbound or outbound call projects as assigned. (10%)
• Performs other duties as assigned or required. (5%)

QUALIFICATIONS:

Minimum

• High School / GED

• 1 year of Nursing in the specialty

• Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).

Preferred

• Bachelor's Degree in Nursing

• 1 year in a Emergency Room/ICU role

• 1 year with adult medicine/surgery

• 1 year in call center or tele-health setting

• Certification in area of expertise

• Valid PA driver's license may be required

• Older Adults Protective Services Act (OAPSA) clearance may be required depending on location

Additional Employment Requirements:

• Act 34 Criminal Background Clearance Certificate

• Act 33 Child Abuse Clearance Certificate

• Act 73 FBI Fingerprinting Criminal Background Clearance Certificate

• CPR certification

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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