Nurse Navigator

Overview

We are looking to add a Nurse Navigator to our growing team in Phoenix, AZ supporting our Kairos Division! As a nurse navigator, your role will be to guide and support our members in understanding their benefits and how best to utilize them. You will serve as a clinical concierge, providing healthcare navigation, proactive outreach, and assistance with claim resolution and prior authorization. Additionally, you will offer disease management and education, acting as a liaison between healthcare professionals, vendors, and other departments or teams. Your goal will be to ensure that our members receive the best possible care and support throughout their healthcare journey.

How You'll Make An Impact

• Ensures effective use of services and manages costs, helping control expenses and ensure fair practices
• Review and analyze claims to understand resources that may be needed for resolution
• Act as a liaison among referral sources, physicians, and members to facilitate cost-effective healthcare solutions and enhance communication
• Collects and analyze data on health outcomes and program participation to assess and improve wellness initiatives, leading to better health outcomes and satisfaction
• Identifies member for referral opportunities to integrate with other services, promoting comprehensive care
• Collaborate with healthcare professionals, vendors, and departments to integrate health and wellness initiatives
• Utilize understanding of case management, insurance plans, and regulations to ensure compliance and effective service delivery
• Connect individuals with healthcare providers and community resources to address specific health needs, improving individual and community health outcomes

Skills For Success

• Strong communication: ability to effectively communicate and present to groups and individuals
• Critical thinking and problem-solving: assess health needs, identify risk factors, and develop appropriate interventions
• Organizational and time management: manage multiple tasks and prioritize workload effectively
• Flexibility and adaptability: ability to adjust approach and strategies based on the needs of individuals and groups
• Collaboration and partnership: work effectively with other healthcare professionals, groups, and community organizations to deliver comprehensive wellness services
• Professionalism and ethical conduct: adhere to ethical and legal standards in healthcare practice and maintain confidentiality
• Continued learning and adaptability: willingness to learn and adapt to new software systems and technological advancements

About You

Required:

• Associate's degree from an accredited school of nursing
• Minimum of 3 years clinical experience in an acute care setting
• Active Registered Nursing license within the state of practice

Preferred:

• BSN
• 3+ year utilization management/case management experience in an insurance (non-hospital) setting
• 3+ years claims review experience including familiarity of reimbursement methodology
• Pre- and post-pay claims review and healthcare data experience preferred
• Experience in quality improvement related activities

Behaviors:

• Demonstrates adequate knowledge of managed care with emphasis on use of criteria, guidelines and national standards of practice
• Demonstrates good written and oral communications, organizational and leadership skills
• Computer literate
• Demonstrates good time management skills
• Self starter
• Ability to travel locally to client sites 1-3x per month within Arizona

Compensation And Benefits

• Competitive compensation
• Comprehensive benefits programs designed to support your well-being
• Career development opportunities and ongoing learning
• A collaborative, people-first culture with accessible leadership
• The opportunity to do meaningful work with global reach and local impact