Nurse Navigator-Endorsed

Company :

Endorsed

Job Description : 

JOB SUMMARY

This job consists of working in a high-volume, fast-paced call center environment in which the nurse assists Highmark members and their caregivers with clinical triage, scheduling and assessing clinical and social support needs. Once the caller’s needs are identified, the nurse uses professional clinical judgement to provide triage to the appropriate site of care, education on applicable program benefits and resources, referrals for additional support, coordination of care, and any other assistance identified as necessary. 

ESSENTIAL RESPONSIBILITIES

• Serves as preliminary contact for Highmark members by: greeting patients via telephone in a pleasant and professional manner, prioritizing patient inquiries, ensuring that demographic information is correctly reflected in the member system, maintaining positive customer service attitude when dealing with the public and Highmark personnel, working effectively as a team member by offering support and/or ideas to enable the group to reach group goals. 
• In a call center setting, provides professional nursing assessments, prioritizes treatments and coordinates appointments according to the urgency of need, and collaborates with other departments to appropriately coordinate member health needs. Ensures activities are documented and conducted in compliance with applicable business process requirements and regulatory requirements.
• Coordinates case management referrals, including aspects of the multi-disciplinary team (physicians, consults, supportive care services, etc.). Educates members on Highmark benefit offerings to close gaps in care, improve their health outcomes and enhance the member experience. 
• Works inbound or outbound call projects as assigned. 
• Assist Highmark non-clinical staff with clinical issues and questions. 
• Performs other duties as assigned or required. 

EDUCATION

Required

• High School/GED

Substitutions

• None

Preferred

• Bachelor's degree in Nursing

EXPERIENCE

Required

• 1 year in Nursing
   

Preferred

• Role in Emergency Room/ICU
• Role in adult medicine/surgery
• Role in call center or tele-health setting

LICENSES or CERTIFICATIONS

Required

• Registered Nurse (RN) license in PA; additional states may be required 

• CPR Certification

Preferred

• PA Drivers License

• Certification in nursing area of expertise

• Older Adults Protective Services Act Clearance; dependent upon location

SKILLS

• Written and verbal presentation skills, excellent interpersonal and negotiation skills, and ability to positively influence others with respect and compassion
• Experience working with health care needs of diverse populations
• Ability to work in a high performing team environment that requires flexibility
• Demonstrated ability to handle multiple priorities in a fast-paced environment; excellent organizational and time management skills
• Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy
• Broad knowledge of disease processes
• Understanding of healthcare costs and the broader healthcare service delivery system
• Understanding of Highmark benefit structures and program offerings

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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