Employment Type:

Shift:

Description:

The Health Alliance Clinical Teamis now hiring for an Nurse Patient Navigatorto 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 within Trinity Healths Colleague Health Plan and Value-Based Care programs. This role ensures members and patients receive high-quality cost-effective and clinicallyappropriate carewhile reducing fragmentation improving outcomes and enhancing the overall experience. The Navigator collaborates with providers health plans care teams and community resources to support population healthobjectivesand value-based performance goals.

Schedule: Monday - Friday 8-5

**Hybrid position working both remote and in person after assigned training period.

Minimum Qualifications

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

• Bachelors degree in nursing Human Resources Healthcare or related field OR equivalent experience.

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

Position Summary and Highlights:

• Emergency Department (ED) Follow-Up: Conduct timely outreach to patients following ED visits to ensure connection to appropriate in network follow-up services.

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

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

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

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

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

• Medically Necessary Care: Facilitate review of providers out of network recommendation assuring services are not available within 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.

• Direct members/patients toappropriate providers programs and resources including urgent care vs. emergency department education.

• Assistinestablishingprimary care and specialty relationships; educate on network navigation and well-being programs.

• Conduct outreach following ED visits to ensuretimelyfollow-up and continuity of care.

• Perform clinical chart reviews toidentifymedically necessary networkdirectionand recommendations.

• Coordinate andmonitorreferrals ensuringtimelyappointments and closing referral loops.

• Collaborate with providers payers and care teams to align care delivery with value-based goals.

• Validate member eligibility and benefits;facilitateauthorization processes asappropriate.

• Identifytrends in access or scheduling; report and recommend improvements using data and KPIs.

• Provide education and feedback to providers on referral patterns and opportunities.

• Participate in quality improvement initiatives including data collection and evaluation.

• Maintain compliance with HIPAA regulatory requirements and organizational policies.

• Serve as an escalation point for member/patient access or care experience issues.

HIGHLIGHTS AND BENEFITS:

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

• We offer market-competitive pay generous PTO and multiple options for comprehensive benefits that begin on day one.

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

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

Visit to learn more!

MINISTRY/FACILITY INFORMATION:

Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho Oregon and northern 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 well-being of people by emphasizing care that is patient-centered physician-led innovative and community-based.

• Top 15 Health Systems in the country by IBM Watson Health;

• The regions most advanced Trauma Center (Level II);

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

Our Commitment

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