Care Navigator (Pennsylvania)

Healthmap Solutions (Healthmap) is an NCQA-accredited industry-leading kidney population health management company. Healthmap uses big data resources, integrated advanced technology, clinical expertise, and complex care management to improve the lives of people living with kidney disease. Healthmap also helps healthcare providers and payers achieve the value-based results they need. Our company is a diverse and growing organization committed to our clients, the patients we support, and our employees.

We are champions for better health, for those who need us most.

Position Summary

The Care Navigator will be responsible for assisting in care coordination and case management duties for all identified patients, specific to kidney health management. The Care Navigator will be available to assist incoming callers in a call queue environment. Daily activities will include maintaining individual metrics, engagement of members into the Care Navigation program, managing a set caseload of mixed acuity members, reviewing and/or obtaining member data, data entry in HealthMap’s Care Management documentation system, completing HRA’s, assessments, member-centric care plans, updates of identified problems, barriers, interventions, and goals, patient teaching, and assistance with ongoing case management. The Care Navigator will notify the providers of changes in patient status, medications, patient-level of care, new problem identification, and updates to the care plan. The Care Navigator will collaborate with the Care Coordinator regarding appointment setting, scheduling, mailings, and care plan coordination needs. The Care Navigator will collaborate with internal as well as external (physicians, nurses, and other healthcare personnel) to assure positive patient outcomes and care coordination. Care Navigator will participate in all care navigation rounds. Care Navigator will identify success stories, specific to Renal Replacement Therapies (RRT), Dialysis, and Renal Transplant as directed.

Responsibilities

• Accountability for individual metrics
• Availability in a call queue environment
• Support after hours, weekends, and various time zones based on business need
• Engage members into HealthMap’s Kidney Health Program
• Management of member-centric care plan, problems, barriers, interventions, and goals as appropriate
• Follow up with members based on complexity and cadence by policy
• Act as the patient advocate responding to and working to resolve patient concerns or barriers
• Performs Care Plan updates and monitoring to develop and assure patient compliance with physician’s orders and care management
• Serves as a resource to patients and physicians. Familiarity with community resources and programs and utilizes in care planning
• Provides Care Navigator activities for the continuum of care to facilitate and promote high quality, cost-effective outcomes for patients and focus on the whole patient and care delivery coordination
• Act as a liaison between the patient, the patient’s support network, treating physician, and other ancillary providers as a member of an interdisciplinary care team to coordinate care, resolve nursing problems and assist patients in meeting individualized goals
• Acts as a preceptor, mentor, and coach for new hire orientees
• Notify Providers of changes in patient status, patient-level of care, new problem identification, and the need for additions the care plan
• Collaborates with the BH Social Worker as appropriate
• Attend Kidney Health Management Care Management Rounds as appropriate
• Review and monitor physician practice medical records for changes in patient condition, new or changed doctors’ orders, medication changes, and lab values specific for Kidney Health Management
• Demonstrated HIPAA understanding and complete confidentiality protocols:
• Demonstrate understanding and sign confidentiality documents
• The employee is expected to comply with HIPAA privacy laws and all other federal, state, and local regulations
• Comply with company security policies
• Follow all company-defined operational policies and procedures
• Uses multiple technical applications including word, excel spreadsheets, electronic calendars, email, and other software applications
• Monitors and manages key performance indicators as identified by the organization level and department level
• Builds strong cross-functional relationships with internal departments as well as physician partners and practice staff
• Use approaches, services, and tools to engage patients and their families in their own care and to support self-management
• Perform evaluation of each patient periodically, and at critical junctures for measurable differences in Clinical, Financial, Quality of Life, and Satisfaction categories
• Document and maintain accurate correspondence logs that will identify all patient communication and plans
• Performs other related duties as assigned

Qualifications

Requirements

• Registered Nurse
• BSN preferred
• Certification in Case Management preferred
• Bilingual Preferred
• 3 or more years of experience in case management
• Experience in a dialysis center or transplant center preferred
• Experience in customer service is strongly preferred

What You Bring To The Team

• Demonstrated Organizational skills
• Demonstrated Knowledge of Case Management and Managed Care
• Strong Motivational Interviewing Technique
• Strong Communication skills
• Knowledge of Medicare, Medicaid preferred
• Ability to work in a fast-paced environment with changing priorities
• Problem-solving capabilities
• Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint

Why Join Healthmap Solutions?

• Be a Champion for Better Health: Healthmap Solutions is transforming the kidney population health management industry and improving the healthcare experience for patients. Healthmap has a proven formula for driving success for its clients and patients.
• Unmatched Expertise in Mapping a Healthier Future: Healthmap Solutions uses proprietary algorithms, big data, and personalized interactions to drive better health outcomes for patients and value-based care for health plans.
• Exciting Opportunities: Healthmap is poised for hyper-growth and needs talent with vision to see the future state and willingness to jump in and build it.
• Meaningful Partnerships: Healthmap Solutions has been recognized as a top employer by numerous media and professional organizations. Talented, passionate individuals make a difference in this fast-moving, collaborative, diverse, and inspiring environment.
• Growth and Innovation: At Healthmap, we are just getting started. Come grow with us and support our mission to make a tangible difference in the lives of our members.

The road to better kidney health management starts with Healthmap Solutions.

As an Equal Opportunity Employer, we will not discriminate against any job candidate or employee due to age, race, religion, ethnicity, national origin, gender, gender identity/expression, sexual orientation, disability, familial status, veteran status, marital status, parental status, or pregnancy. In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.