Care Navigator - Utilization Management (per diem)

Overall Purpose

Under the supervision of the Medical Management Nurses, this position is responsible for assisting the nurses with Medical Management processes that do not require RN intervention, based on the scope of practice within the state. Through case finding, data and other tools, high risk patients will be identified and guided to enhance the achievement of the Quadruple Aim: improved outcomes, improved experience of care for patients and providers and lower healthcare costs.

Education and Experience

• High School graduate required
• Education as a medical assistant or nursing school student helpful
• Strong problem-solving skills required
• Experience in a managed care organization preferred

Knowledge, Skills and Abilities

• Friendly and compassionate disposition
• Proficiency with computer, software programs (i.e. Microsoft Word, Excel) and internet required
• Excellent communication and problem-solving skills
• Excellent organizational and time management skills
• Ability to learn quickly
• Ability to handle a fast-paced environment and prioritize tasks based on importance
• Strong interpersonal communication skills
• Ability to work independently or as part of a team
• Dedication to maintaining confidentiality of all patient records
• Knowledge of medical terminology required
• Ability to demonstrate knowledge of vital signs and other clinical skills to obtain and maintain employment
• Familiarity with EMR’s

Essential Functions

• Promote the mission, vision and values of P3 Health Partners
• Codifies patient care activities between UM and CM for assigned patient populations
• Performs administrative functions to support UM and CMM
• Makes initial follow-up telephone calls to patients discharged from a facility, acute or post-acute, unless acuity requires RN to perform
• Outreach and guidance to non-high-risk patients
• Manages ER utilization report and interventions, per policy, to address inappropriate ER utilization
• Aids Medical Management team in gathering additional clinical information when applicable
• Aids the Medical Management team with appropriate referrals, claims history or any other clinical information necessary
• Responsible for timely and accurate documentation in systems
• Develops spreadsheets and other tools to support Medical Management team
• Aids patients in obtaining / coordinating community and other resources

Work Location & Schedule

This role offers either an on-site or fully remote work arrangement. Candidates within a 50‑mile radius of a company office will follow our on-site schedule. Candidates located outside this radius will work remotely, with occasional travel to offices for meetings or key events.

Pay Rate range

$22.00 - $25.00 based on experience