The Health Plan of West Virginia Inc
Location
Wheeling, West Virginia
The Nurse Navigator coordinates and provides case management services, performing comprehensive assessments of medical, behavioral, functional, and social determinant of health factors to develop and maintain individualized care plans. Responsibilities include facilitating care aspects across the continuum, acting as an advocate for members, arranging community services, and documenting all interactions and workflows to ensure regulatory adherence.
Candidates must be a Registered Nurse with a minimum of five years of experience, including three years in a clinical setting, and hold active Ohio or West Virginia licensure. Essential requirements include excellent oral, written, and interpersonal skills, proficient computer literacy, the ability to work independently and in a team, and a commitment to accountability and sound independent judgment.
The D-SNP (Dual-Eligible Special Needs Plan) Nurse Navigator is responsible for the navigation and advocacy of members who are dually eligible for both Medicare and Medicaid. These members often have multiple or complex medical and/or behavioral health, socioeconomic, and functional needs that require comprehensive care coordination services. These services may include navigation beyond the specific case or situation, providing the member with a wide spectrum of services directed at not only medical or behavioral changes but healthy lifestyles and optimal outcomes assuring quality and continuity of care within the managed care system.
Care coordination directs intervention by offering education and support, liaising with providers of medical/behavioral services and equipment to facilitate effective communication, streamline referrals, assist in developing and implementing comprehensive individualized care plans, and supporting smooth discharge planning. This is achieved through the establishment of routine follow up to monitor, evaluate, revise or close care plan interventions and goals which support ongoing communication and interaction among the interdisciplinary care team and provides opportunities to appraise cases for quality of care.
1. Utilization Management, Quality Improvement, Case Management, Disease Management, or other Managed Care experience is desirable. 2. Certification in an area of clinical expertise related to current work i.e., CDE, CCM, CMCN, Motivational Interviewing/MI Trainer, etc.
The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
8:00am - 5:00pm 40
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