Care Navigation Registered Nurse in Gilbert, AZ
Job Description
Care Navigator Registered Nurse
Join our dedicated interdisciplinary care integration team (CIT) as a Care Navigator Registered Nurse. In this impactful role, you will play a vital part in enhancing patient care by proactively engaging patients and implementing targeted interventions aimed at improving their overall health and increasing access to necessary healthcare services. You will provide guidance and support to care coordination efforts among team members while effectively managing clinical escalations.
This position calls for an understanding of socio-economic factors that can influence patient engagement in healthcare and their resulting health outcomes. We seek candidates with experience in care or case management, particularly in transitions of care and high-risk patient management programs in collaboration with primary care teams and community partners.
Responsibilities:
• Manage transitions of care for patients, including follow-ups after hospital stays, observations, and post-acute care.
• Provide expert triage advice and consultation to team members on complex cases.
• Utilize the 5Ms Geriatric best practice framework to develop comprehensive care plans.
• Assess and address patient needs, focusing on Social Determinants of Health.
• Identify barriers to healthcare access and engagement and work to overcome them.
• Educate patients about chronic health condition management and available behavioral healthcare options.
• Act as a liaison between patients and their care providers, facilitating navigation of both internal and external systems.
• Initiate care planning and collaborate with the interdisciplinary team for high-risk patients.
• Support and motivate patients to achieve their health objectives.
• Refer patients to essential services and support systems as needed.
Additional responsibilities may include:
• Assisting with transportation and food insecurity, guiding patients through benefits applications like Medicaid and HCBS, reducing prescription medication costs, organizing follow-up appointments, and alleviating social isolation.
• Leading interdisciplinary team meetings when necessary.
• Conducting family assessments and meetings with patients and their families as needed.
• Participating in training content development and facilitation for the team.
• Taking part in interdisciplinary reviews and coordination for complex patient cases.
• Ensuring patient confidentiality in line with HIPAA regulations.
• Documenting patient interactions promptly and accurately in the medical record system.
• Adhering to general policies regarding fire safety, infection control, and attendance.
• Performing other duties as required.
Qualifications:
• Required: Registered Nurse (RN license) and a minimum of 4 years of experience in human services with community-based resource navigation.
• Preferred: Experience in care/case management, familiarity with value-based care, working with complex senior populations, and effective interdisciplinary teamwork. Bilingual in English and Spanish or Creole with full proficiency in all aspects of the language is a bonus.
Skills Required:
• Strong clinical skills and acumen.
• Ability to manage multiple tasks efficiently in a fast-paced environment.
• Adaptable to changing responsibilities and environments.
• Excellent organizational and communication skills.
• Strong interpersonal and relationship-building abilities.
• Compassion and a commitment to advocating for patient needs.
• Critical thinking and problem-solving skills.
Working Conditions:
This role requires a mobile presence, involving regular onsite engagement with care teams at assigned clinics to meet with patients in person and collaborate with team members.
Workstyle: Hybrid - A blend of in-clinic and remote/virtual work.
Location: Must reside in the Phoenix metro area.
Work Hours: Must commit to a 40-hour work week, Monday through Friday, from 8:00 AM to 5:00 PM, with potential for additional hours to meet business needs.
Tuberculosis (TB) Screening: This position involves direct patient interaction; therefore, a TB screening will be required if selected.
Driver's License and Transportation: This role is under Humana's Driver safety program, requiring a valid driver's license, necessary insurance coverage, and reliable transportation.
Scheduled Weekly Hours: 40 hours.
Pay Range: We offer a competitive salary, estimated at $71,100 - $97,800 per year, based on various factors including experience and qualifications. This position is eligible for a performance-based bonus incentive plan.
Description of Benefits: Humana provides comprehensive benefits supporting overall well-being, including medical, dental, and vision plans, retirement savings options, generous paid time off, disability coverage, life insurance, and more.
About Us: CenterWell Senior Primary Care focuses on delivering proactive, preventive care for seniors, combining compassion and personalized approaches in our services. As a part of Humana, we are committed to fostering the health and well-being of our communities and offer outstanding career development opportunities.
Equal Opportunity Employer: Humana is dedicated to maintaining a work environment that values diversity and inclusivity. We do not discriminate against any individual based on race, color, religion, gender, sexual orientation, national origin, age, disability, or veteran status.
Join our dedicated interdisciplinary care integration team (CIT) as a Care Navigator Registered Nurse. In this impactful role, you will play a vital part in enhancing patient care by proactively engaging patients and implementing targeted interventions aimed at improving their overall health and increasing access to necessary healthcare services. You will provide guidance and support to care coordination efforts among team members while effectively managing clinical escalations.
This position calls for an understanding of socio-economic factors that can influence patient engagement in healthcare and their resulting health outcomes. We seek candidates with experience in care or case management, particularly in transitions of care and high-risk patient management programs in collaboration with primary care teams and community partners.
Responsibilities:
• Manage transitions of care for patients, including follow-ups after hospital stays, observations, and post-acute care.
• Provide expert triage advice and consultation to team members on complex cases.
• Utilize the 5Ms Geriatric best practice framework to develop comprehensive care plans.
• Assess and address patient needs, focusing on Social Determinants of Health.
• Identify barriers to healthcare access and engagement and work to overcome them.
• Educate patients about chronic health condition management and available behavioral healthcare options.
• Act as a liaison between patients and their care providers, facilitating navigation of both internal and external systems.
• Initiate care planning and collaborate with the interdisciplinary team for high-risk patients.
• Support and motivate patients to achieve their health objectives.
• Refer patients to essential services and support systems as needed.
Additional responsibilities may include:
• Assisting with transportation and food insecurity, guiding patients through benefits applications like Medicaid and HCBS, reducing prescription medication costs, organizing follow-up appointments, and alleviating social isolation.
• Leading interdisciplinary team meetings when necessary.
• Conducting family assessments and meetings with patients and their families as needed.
• Participating in training content development and facilitation for the team.
• Taking part in interdisciplinary reviews and coordination for complex patient cases.
• Ensuring patient confidentiality in line with HIPAA regulations.
• Documenting patient interactions promptly and accurately in the medical record system.
• Adhering to general policies regarding fire safety, infection control, and attendance.
• Performing other duties as required.
Qualifications:
• Required: Registered Nurse (RN license) and a minimum of 4 years of experience in human services with community-based resource navigation.
• Preferred: Experience in care/case management, familiarity with value-based care, working with complex senior populations, and effective interdisciplinary teamwork. Bilingual in English and Spanish or Creole with full proficiency in all aspects of the language is a bonus.
Skills Required:
• Strong clinical skills and acumen.
• Ability to manage multiple tasks efficiently in a fast-paced environment.
• Adaptable to changing responsibilities and environments.
• Excellent organizational and communication skills.
• Strong interpersonal and relationship-building abilities.
• Compassion and a commitment to advocating for patient needs.
• Critical thinking and problem-solving skills.
Working Conditions:
This role requires a mobile presence, involving regular onsite engagement with care teams at assigned clinics to meet with patients in person and collaborate with team members.
Workstyle: Hybrid - A blend of in-clinic and remote/virtual work.
Location: Must reside in the Phoenix metro area.
Work Hours: Must commit to a 40-hour work week, Monday through Friday, from 8:00 AM to 5:00 PM, with potential for additional hours to meet business needs.
Tuberculosis (TB) Screening: This position involves direct patient interaction; therefore, a TB screening will be required if selected.
Driver's License and Transportation: This role is under Humana's Driver safety program, requiring a valid driver's license, necessary insurance coverage, and reliable transportation.
Scheduled Weekly Hours: 40 hours.
Pay Range: We offer a competitive salary, estimated at $71,100 - $97,800 per year, based on various factors including experience and qualifications. This position is eligible for a performance-based bonus incentive plan.
Description of Benefits: Humana provides comprehensive benefits supporting overall well-being, including medical, dental, and vision plans, retirement savings options, generous paid time off, disability coverage, life insurance, and more.
About Us: CenterWell Senior Primary Care focuses on delivering proactive, preventive care for seniors, combining compassion and personalized approaches in our services. As a part of Humana, we are committed to fostering the health and well-being of our communities and offer outstanding career development opportunities.
Equal Opportunity Employer: Humana is dedicated to maintaining a work environment that values diversity and inclusivity. We do not discriminate against any individual based on race, color, religion, gender, sexual orientation, national origin, age, disability, or veteran status.
Job Details
Medical Speciality
GeriatricsPrimary Care
Employment Type
Full-time
Required License
RN (Registered Nurse)
Work Setting
Clinic
About Humana
Humana Inc. is a health and well-being company in the United States, offering medical and supplemental benefit plans to individuals and employer groups. The company operates through three segments: Retail, Group and Specialty, and Healthcare Services, providing a range of health insurance benefits, pharmacy solutions, provider services, and home health services to its members. With approximately 17 million members in medical benefit plans and 5 million in specialty products, Humana serves individuals, employer groups, and government programs, including Medicare and Medicaid.