Nurse Navigator

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We are looking to add a Nurse Navigator to our growing team in Phoenix, AZ supporting our Kairos Division!  As a nurse navigator, your role will be to guide and support our members in understanding their benefits and how best to utilize them. You will serve as a clinical concierge, providing healthcare navigation, proactive outreach, and assistance with claim resolution and prior authorization. Additionally, you will offer disease management and education, acting as a liaison between healthcare professionals, vendors, and other departments or teams. Your goal will be to ensure that our members receive the best possible care and support throughout their healthcare journey.

• Ensures effective use of services and manages costs, helping control expenses and ensure fair practices

• Review and analyze claims to understand resources that may be needed for resolution 

• Act as a liaison among referral sources, physicians, and members to facilitate cost-effective healthcare solutions and enhance communication

• Collects and analyze data on health outcomes and program participation to assess and improve wellness initiatives, leading to better health outcomes and satisfaction

• Identifies member for referral opportunities to integrate with other services, promoting comprehensive care

• Collaborate with healthcare professionals, vendors, and departments to integrate health and wellness initiatives

• Utilize understanding of case management, insurance plans, and regulations to ensure compliance and effective service delivery

• Connect individuals with healthcare providers and community resources to address specific health needs, improving individual and community health outcomes 

Skills for success: 

• Strong communication: ability to effectively communicate and present to groups and individuals  

• Critical thinking and problem-solving: assess health needs, identify risk factors, and develop appropriate interventions 

• Organizational and time management: manage multiple tasks and prioritize workload effectively 

• Flexibility and adaptability: ability to adjust approach and strategies based on the needs of individuals and groups 

• Collaboration and partnership: work effectively with other healthcare professionals, groups, and community organizations to deliver comprehensive wellness services 

• Professionalism and ethical conduct: adhere to ethical and legal standards in healthcare practice and maintain confidentiality 

• Continued learning and adaptability: willingness to learn and adapt to new software systems and technological advancements 

Required: 

• Associate's degree from an accredited school of nursing 

• Minimum of 3 years clinical experience in an acute care setting 

• Active Registered Nursing license within the state of practice

Preferred: 

• BSN  

• 3+ year utilization management/case management experience in an insurance (non-hospital) setting

• 3+ years claims review experience including familiarity of reimbursement methodology

• Pre- and post-pay claims review and healthcare data experience preferred

• Experience in quality improvement re

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