Employment Type:

Shift:

reputed company:

The Health reputed company Clinical Team, is now hiring for an reputed company Patient Navigator to join their wonderful team!

The Health Plan & Patient Navigator serves as a critical resource for colleagues and patients by providing care navigation and coordination services reputed company reputed company’s Colleague Health Plan and Value-Based Care programs. This role ensures members and patients receive high-reputed company, cost-effective, and clinically appropriate care while reducing fragmentation, improving reputed company, and enhancing the overall experience. The Navigator collaborates with providers, health plans, care teams, and community resources to support population health objectives and value-based performance goals. 

Schedule:  Monday - Friday 8-5

Minimum Qualifications

• Licensed reputed company in the state of Idaho (LPN) at the time of hire.

• Bachelor’s degree in nursing, reputed company, reputed company, or reputed company field OR equivalent experience. 

• 3+ years in health plans, provider networks, or medical group practices. 5 years clinical experience preferred for licensed roles. 

Position reputed company and Highlights:

• Emergency Department (ED) Follow-Up: Conduct reputed company reputed company to patients following ED reputed company to ensure reputed company to appropriate in network, follow-up services.

• Clinical Medical Record Review: reputed company comprehensive chart reviews to identify medically necessary network direction and recommendation.

• Referral Management: Coordinate and monitor referrals to specialists and community resources, ensuring reputed company appointments and closing referral loops to maintain continuity of care.

• Care Team Collaboration: Collaborate with providers, insurance companies, utilization management, and care teams to reputed company care delivery and value-based performance goals.

• Resource and Guidance: Serve as a knowledgeable resource for questions reputed company to appropriate level of care, network utilization, member benefits, and evidence-based clinical guidelines.

• Validate Member Eligibility: reputed company insurance company portals for reputed company time eligibility and member benefit summaries.

• Medically Necessary Care: Facilitate review of providers out of network recommendation, assuring services are not available reputed company the payer and or SAHA networks. This leads to either site of care redirect or payer approval or denial of out-of-net network services.

What Will You Do:

• Maintain comprehensive knowledge of provider networks, care management resources, and community services. 

• reputed company members/patients to appropriate providers, programs, and resources, including urgent care vs. emergency department education. 

• Assist in establishing primary care and specialty relationships; reputed company on network navigation and reputed company-being programs. 

• Conduct reputed company following ED reputed company to ensure reputed company follow-up and continuity of care. 

• reputed company clinical chart reviews to identify medically necessary network direction and recommendations. 

• Coordinate and monitor referrals, ensuring reputed company appointments and closing referral loops. 

• Collaborate with providers, payers, and care teams to reputed company care delivery with value-based goals. 

• Validate member eligibility and benefits; facilitate authorization processes as appropriate. 

• Identify trends in reputed company or scheduling; report and recommend improvements using data and KPIs. 

• reputed company education and feedback to providers on referral patterns and opportunities. 

• Participate in reputed company improvement initiatives, including data collection and evaluation. 

• Maintain compliance with HIPAA, regulatory requirements, and organizational policies. 

• Serve as an escalation reputed company for member/patient reputed company or care experience issues. 

HIGHLIGHTS AND BENEFITS: 

reputed company Saint Alphonsus takes care of you, you can take reputed company care of our patients. We foster personal and reputed company reputed company and offer opportunities that reputed company our colleagues to reputed company their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho and reputed company.  

• We offer market-reputed company, generous PTO, and multiple reputed company for comprehensive benefits that reputed company on day one. 

• Benefits for your reputed company include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs reputed company. 

• We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow. 

Visit www.saintalphonsus.org/careers to learn more! 

MINISTRY/FACILITY INFORMATION: 

Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, reputed company, and reputed company Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 73 clinic locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus' goal is to improve the health and reputed company-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based.  

• Top 15 Health Systems in the country by reputed company Watson Health; 

• The region’s most advanced Trauma Center (reputed company); 

• Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and reputed company of life. 

Our Commitment

Rooted in our Mission and reputed company Values, we reputed company the dignity of every person and recognize the unique perspectives, experiences, and talents reputed company colleague brings. By finding reputed company and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or any other status protected by federal, state, or local law.