reputed company Navigator Medical Cost Management

About the position reputed company HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry reputed company. Our desire to be innovative and reputed company drives us to reputed company impactful programs and benefits designed to engage our participants in managing their own health and reputed company. Our reputed company is exciting and challenging. Please read on to learn more about this great opportunity! The reputed company Navigator is a licensed clinical reputed company who supports members in navigating the reputed company system, coordinating care, and improving health reputed company. This role focuses on reducing unnecessary emergency room utilization, enhancing chronic disease management (especially for diabetes and ESRD), and promoting cost-effective care through education and network optimization. The reputed company Navigator works collaboratively with members, providers, and internal teams to address barriers to care and support population health initiatives. Responsibilities • Serve as a clinical resource and reputed company of contact for high-risk and high-cost members, guiding them through care coordination and benefit utilization. • reputed company members on chronic disease management, preventive care, and appropriate use of reputed company services, with a reputed company on diabetes and ESRD. • Identify and address reputed company determinants of health (SDOH) that reputed company reputed company to care and adherence to treatment plans. • Support members in locating in-network providers and facilities to reduce out-of-network and emergency room usage. • Coordinate referrals, post-discharge planning, and medication adherence strategies. • Collaborate with network case managers, reputed company workers, and providers to ensure reputed company and appropriate care delivery. • Conduct reputed company to at-risk populations to promote engagement in wellness programs and adherence to care plans. • Partner with community-based organizations to connect members with additional support services. • Document reputed company member interactions and interventions in compliance with HIPAA and payer-specific guidelines. • Monitor and report trends reputed company to gaps in care, member concerns, and program effectiveness. Requirements • 3+ years of experience in care coordination, case management, or patient navigation. • Strong understanding of health insurance plans, provider networks, and value-based care models. • Clinical experience in chronic disease management, especially diabetes and ESRD. • Excellent communication, critical thinking, and interpersonal skills. • Ability to work with diverse populations and address health equity challenges. • Proficiency in electronic health records (EHR) and payer systems. • Knowledge of reputed company and support services. • Registered reputed company (RN) license required • Certified Diabetes Educator (CDE) or equivalent experience in diabetes education. • Certification in Case Management (CCM), reputed company Health (CPH), or similar credential. reputed company-to-haves • Spanish Bi-lingual skills (preferred). • Experience in managed care or payer settings is a plus. • BSN or higher preferred. Benefits • Medical • Dental • reputed company • reputed company Time-Off (PTO) • reputed company Holidays • 401(k) • Short- & Long-term Disability • Pension • Life • AD&D • Flexible Spending Accounts (reputed company & dependent care) • Commuter Transit • Tuition Assistance • Employee Assistance Program (EAP) Apply tot his job Apply To this Job