Five Star Nurse Navigator (full-time hourly / remote / hybrid)

Job Summary

The role of the Five Star Nurse Coordinator is to provide a clinically enhanced member experience, working collaboratively with FiveStar Navigators and nurses on clinical member needs as assigned. They document interactions and guidance provided to members, work with customer clinics/DPCs on care navigation needs, coordinate with contracting entities, and promote preventive screens and adherence to national guidelines.

Summary Of Essential Job Functions

• Navigate members to high value providers based on member's needs for services within the available direct contracts or bundles/episodes of care.
• Work collaboratively with FiveStar Navigators and nurses on clinical member needs as assigned.
• Document interactions and guidance provided to members.
• Work with customer clinics/DPCs on care navigation needs.
• Cook up coordination with vendor partners and internal FiveStar and nursing teams to ensure collaboration on member needs.
• Create out of area student plan with regard to network access.
• Coordinate with second opinion entities and programs as needed.
• Provide member education.
• Internal referrals to pre-cert, UM, CM, DM and Optimal Health as needed based on member needs.
• Coordinating care or services as needed.

Position Requirements

• Education – LPN or ADN required with current licensure in good standing.
• Effective communication skills including oral, nonverbal and written.
• Ability to work collaboratively with the Health Services team and other PSE departments.
• Strong organizational skills.
• Strong sense of customer service.
• Ability to work with diverse individuals.
• Adherence to and application of HIPAA regulations.
• Experience – 3 years in a clinical or hospital setting.
• Computer Skills: Word, Excel, Microsoft Outlook, keyboarding and data entry.
• Experience in utilization review, concurrent review and /or discharge planning.
• Telephone etiquette.
• Must be able to carry on conversations with medical providers, and members to facilitate good understanding by all parties.

Required Competencies

• Change Management – Accepts, supports, and executes assignments in conditions of change which support attaining department goals.
• Effective Communication – Demonstrates effective and responsive communications following the appropriate reporting structure.
• Accountability/Results – Achieves and/or exceeds result based goals that were specific, measurable, and timely.
• Teamwork – Demonstrates teamwork behaviors and makes positive contributions and which support the achievement of department goals.
• Customer Satisfaction – Dedicated to the PSE service model and meets or exceeds PSE customer satisfaction expectations in providing exemplary service.
• Professional Growth – Takes ownership of one’s professional growth within one’s current position and to advancement at PSE.

PHYSICAL DEMANDS / WORK ENVIRONMENT

• This is a sedentary position which requires the individual to sit for long periods of time.
• It is encouraged that individuals intermix this sedentary time with periodic movement within one’s office space and/or to other office areas to counteract the sedentary nature of this position.

COMPENSATION AND BENEFITS

• Competitive compensation based on experience and a comprehensive benefit package provided to include Medical, Dental, Vision, Life, STD/LTD, FSA, Paid Time Off, 401k with match, wellness and exercise membership and more.

Opportunity

If this sounds like you and you're seeking career growth with an exciting new career path in overseeing the quality of health care for our clients and their members, please send your cover letter and resume following the instructions for this site.

Prairie States Enterprises Equal Opportunity Employer