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RN - Nurse Navigator - Nurse Navigator

Company: Prominence Health Plan
Location: Mcallen
Posted on: September 13, 2023

Job Description:

RN - Nurse NavigatorResponsibilities

Job Summary: The ACO Nurse Navigator is a registered nurse who functions as a liaison between the ACO, the patient and the multidisciplinary healthcare team to assist in developing an optimal plan of care for transitioning Medicare patients, primarily those being discharged from hospital inpatient or emergency department services. The ACO Nurse Navigator assesses needs and coordinates resources within and outside the ACO (as approved by the ACO Director) to promote optimal health benefits and outcomes (both clinical and financial). The ACO Nurse Navigator will provide onsite review at the local UHS Acute facility, and establish rapport with local hospital case management, hospitalist, ER case management, and discharge planning staffs to expedite timely transitions of care and discharge of ACO patients.

This position requires a high frequency of contact with the very high risk ACO patient and their care givers for education of health promotion and self-care skills as well as facilitating compliance with the required quality measures for all ACO patients. A Patient Navigator will also ensure the coordination and communication of a patient's treatment plan and general status to all care givers during all transitions of care. This position requires advanced nursing knowledge and expertise to identify and implement improvement processes and the ability to direct and implement care coordination plans both in both in-patient and out-patient settings.


Job Duties/Responsibilities:

* Collaborates with physicians, acute/sub-acute case management staff, patients and deemed patient representative to identify patient needs/resources and discharge requirements.
* Ability to earn and maintain trust of patients, patient representatives, physicians and health care providers.
* Identifies needs of the patient and patient representatives and ensures sensitivity to any special needs of the patient.
* Identifies high-risk patients and coordinates resources to conserve.
* Facilitates problem solving and decision-making by providing guidance, knowledge of disease management systems, wellness resources, and supportive services and options to the patient, patient representative and health care providers.
* Timely documented communication and education with physician, patients and patient representatives regarding opportunities for modification of patient health risk factors.
* Participates in care conferences to enhance communication and promote continuity of care.
* Works closely with the ACO staff as well as contracted vendors and support staff to facilitate timely transitions of care.
* Researches service resources in the community and elsewhere to meet patient needs consistent with plan benefits.
* Prepares accurate and timely required department reports related to utilization.


* Graduation from an accredited nursing education program.
* Licensed by the State of Texas to practice as a registered nurse.
* Minimum of three years of Utilization Review/Case Management experience preferred.
* Recent (within past 3 years) working knowledge of Interqual criteria and Milliman Care Guidelines preferred.
* Minimum of three years in clinical medical/surgical nursing practice within a hospital setting.
* Ability to effectively communicate in English, both verbally and in writing.
* Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) Preferred
* Ability to document in different electronic health records as well as utilize Microsoft Products

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.


At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: or 1-800-852-3449.

Keywords: Prominence Health Plan, McAllen , RN - Nurse Navigator - Nurse Navigator, Healthcare , Mcallen, Texas

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