Care Navigator Utilization Management (per diem)

People. Passion. Purpose.

At P3 Health Partners our promise is to guide our communities to better health unburden clinicians align incentives and engage patients.

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care transforming it from sickness care into wellness guidance.

We are looking for a Care Navigator. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization then you should consider joining our team.

*This is a per diem role. May work nights holidays and weekends. Approximately 10 hours per week.

Care Navigator - Utilization Management

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 of medical terminology required
• Excellent communication skills with patients providers internal and external customers required
• Must have excellent computer skills
• Must have excellent organizational skills and ability to work independently

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 EMRs

Essential Functions:

• Promote the mission vision and values of P3 Health Partners
• Coordinates patient care activities between UM and CM for assigned patient populations
• Provides administrative functions to support UM and CM
• Makes initial follow up telephone call to patients discharged from a facility acute or post-acute unless acuity requires RN to perform
• Provides outreach and guidance to non-high-risk patients
• Responsible for managing ER utilization report and interventions per policy to address inappropriate ER utilization
• Assists Medical Management team in gathering additional clinical information when applicable
• Supports 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
• Assists 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 50âmile 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