This listing was posted on Professional Diversity Network.
Care Navigator
Location:
Allentown, PA
Description:
Imagine a career at one of the nation's most advanced health networks.Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.SummaryPerforms all utilization management functions including prior authorization, concurrent review, post-service authorization review, and discharge planning for both inpatient and outpatient service requests utilizing industry standard clinical guidelines to support clinical decision making. Coordinates care and resource utilization for members of the health plan that are patient centric, timely, and provided in the appropriate level of care. Advocates for patient and family in the health care system to decrease fragmentation, duplication of services, improve quality outcomes, and to support stewardship of health care resources. Job DutiesInterprets and applies established guidelines or policies to render certification decisions and documents accurately in the clinical work flow system for medical, behavioral health, and pharmacy requests.Collects and interprets clinical information relevant to patient's diagnosis and accurately assigns codes relevant to diagnosis and procedure codes.Assists members in navigating through the healthcare continuum including, but not limited to, transitions of care, care and disease management referrals, community resources, and provider network utilization.Prepares for and consults with the Medical Director when unable to certify care.Develops and articulates a proposed plan of alternate care to the Medical Director as appropriate when requests are denied.Implements non-traditional collaborative creative solutions to challenging patient management situations when appropriate.Initiates and arranges level of care transitions through discharge planning.Collaborates with medical leadership to ensure compliance with legal, regulatory, and accreditation requirements for the health plan(s) managed.Follows established policies for denials and appeals within time lines and communicates results clearly to stakeholders.Performs as a mentor for team members and new colleagues as needed within the department.Demonstrates ability to learn and utilize computer technology to efficiently perform job.Advocates assertively for member rights as needed with stakeholders to ensure optimal outcomes for members.Participates in collaborative interdepartmental meetings to discuss complex cases.Minimum QualificationsBachelor's Degree in nursing; experience in lieu of bachelor's degree may be considered. 5 years of clinical experience and2 years experience in case coordination, utilization management, case management, disease management, or health insurance. Critical thinking, problem solving, and decision making skills. Excellent caseload and time management skills. Familiarity with benefit plan design and ability to understand and explain the ramifications on patient care decision making. CCM - Certified Case Manager CCMC - State of Pennsylvania within 3 Years orCMCN - Certified Managed Care Nurse ABMCN - State of Pennsylvania within 3 Years RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire Physical DemandsLift and carry 7 lbs., continuous sitting >67%, frequent keyboard use/repetitive motion, frequent fine motor activity/wrist position deviation.Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.Influenza vaccination and COVID-19 Vaccination is required for all colleagues unless medically contraindicated or due to a bona fide religious belief or practice. Applicants possessing a medical marijuana card will not be considered for safety sensitive positions.Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.https://youtu.be/GD67a9hIXUY
Company:
Lehigh Valley Health Network
Industry:
Other
Posted:
May 15 on Professional Diversity Network
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Care Navigator is a Other Jobs Care Navigator Job at Lehigh Valley Health Network located in Allentown PA. Find other listings like Care Navigator by searching Oodle for Other Jobs Care Navigator Jobs.
Care Navigator is a Other Jobs Care Navigator Job at Lehigh Valley Health Network located in Allentown PA. Find other listings like Care Navigator by searching Oodle for Other Jobs Care Navigator Jobs.