Job: ACO Care Navigator

This posting has expired and is no longer available.

Browse Similar Jobs: Healthcare - Admin/Office/Records/Finance Healthcare - Assisted Living/Home Health

Jobing Description

SUMMARY: The Care Navigator serves as a resource and liaison to specific physician practices and the ACO patients they care for. This individual will consult with patients who need assistance understanding their service provider options, benefits, the financial impact of care decisions, and who also may benefit from direction to the ACO Case Manager, Disease Management programs, or Clinical special programs.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: Other duties may be assigned.
1. Develops strong liaison relationship with assigned ACO practices as an additional member of the existing Clinical ICT.
2. Conducts both on-site and telephonic training of physicians and staff about ACO operations, network provider options, and systems.
3. Upon referral from an ACO physician practice, outreaches to patients to provide needed assistance or guidance, such as information about out-of-pocket costs, identification of optimum providers for services needed, encouragement for and facilitation of preventive screenings and chronic care services.
4. Triages as needed to other ACO services, such as case management nurse or admin support. Works collaboratively with the ACO ICT, Network Management, and the physician offices to ensure patients‚ experience and outcomes are optimized.
5. Researches benefit issues and communicates findings to patients and providers.
6. Facilitates pre-certification of services as needed.
7. Assists in the distribution of educational materials to the provider‚s offices, such as tool kits, ACO network provider cost and quality data.
8. Assists in the development of solutions for provider offices, to enable more operational efficiency and effectiveness as they care for ACO patients.
9. Assists in the enhancement of communication between multiple physicians caring for an ACO patient.
10. Attends network meetings such as GMM, OMM, and others as scheduled for communication enhancement.

Skills / Requirements

EDUCATION and/or EXPERIENCE: Licensed Vocational Nursing Program, Medical Assistant Program, Associates degree (A.A.) or equivalent from two year college or technical school; minimum 5 years related experience with a strong understanding of MHC operations, HMO and PPO health plans, health care benefit designs, physician office practice operations, medical terminology and/or equivalent combination of education and experience.

LICENSES, CERTIFICATES, REGISTRATIONS: L.V.N. strongly preferred. Must possess and maintain a current/valid California Driver‚s License and insurance.

OTHER SKILLS and ABILITIES: Proficiency in Microsoft Office, i.e., Word, Excel, and Outlook. Operates general office equipment, i.e. Copier and fax. Ability to navigate Internet. Familiarity with Practice Connect® system.