Care Navigator (RN)-PBG
Centerwell
Become a part of our caring community and help us put health first
Working within an interdisciplinary care team, the Care Navigator is responsible for proactively engaging patients identified as high-risk and implementing targeted interventions to address social needs and increase access to care. The Care Navigator will provide guidance and oversight of care coordination efforts to other members of the team, and handle clinical escalations as indicated.
This role requires an understanding of how socio-economic stressors can impact ability to engage in healthcare and subsequent health outcomes. Experience will ideally include prior work with patients with behavioral health diagnoses, as well as in navigating local community-based resources and benefit applications.
This role has a mobile presence, involving travel to patients’ homes, treatment facilities and community-based settings, and assigned clinics to facilitate and foster connections.
Use your skills to make an impact
About Us
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Working within an interdisciplinary care team, the Care Navigator is responsible for proactively engaging patients identified as high-risk and implementing targeted interventions to address social needs and increase access to care. The Care Navigator will provide guidance and oversight of care coordination efforts to other members of the team, and handle clinical escalations as indicated.
This role requires an understanding of how socio-economic stressors can impact ability to engage in healthcare and subsequent health outcomes. Experience will ideally include prior work with patients with behavioral health diagnoses, as well as in navigating local community-based resources and benefit applications.
This role has a mobile presence, involving travel to patients’ homes, treatment facilities and community-based settings, and assigned clinics to facilitate and foster connections.
Major Duties and Responsibilities
Conduct Transitions of Care Management for a subset of the patient population, including ER and hospital follow upsProvide triage guidance and supportive consultation to other team members, handling escalated complex casesDevelop care plans leveraging 5Ms Geriatric best practice frameworkDevelop a wholistic view of patient needs related to Social Determinants of HealthIdentify existing barriers to engagement with necessary resources and supportsProvide education around maintenance of chronic health conditions, as well as available options for behavioral care and social supportServe as liaison between the patient and the direct care providers, assisting in navigating both internal and external systemsInitiate care planning and subsequent action steps for high-risk members, coordinating with interdisciplinary teamSupporting patients’ self-determination, motivate patients to meet the health goals they have identifiedRefer patient to necessary services and supportsThis field may include but is not limited to: assistance with transportation, food insecurity, navigation of and application for benefits including, Medicaid, HCBS, working to reduce costs associated with prescription medications, organizing schedules of follow up appointments, alleviating social isolationLead Interdisciplinary Team Meetings when indicatedAssess patient’s family system, and conduct family meetings with patient and family when neededParticipate in creation and facilitation of team training contentConduct group psychoeducation and support groups within the CenterPerform all other duties and responsibilities as requiredParticipate in and lead interdisciplinary review of and coordination around complex patientsMaintain patient confidentiality in accordance with HIPAADocument patient encounters in medical record system in a timely mannerFollow general policies related to fire safety, infection control and attendance
Use your skills to make an impact
Required Qualifications
Registered Nurse with 2 years of experience of in home case/care managementExperience working with the adult populationKnowledge of community health and social service agencies and additional community resourcesAbility to travel to member's residence within 30 to 40 milesExceptional communication and interpersonal skills with the ability to quickly build rapportAbility to work with minimal supervision within the role and scopeAbility to use a variety of electronic information applications/software programs including electronic medical recordsIntermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and ExcelExcellent keyboard and web navigation skillsAbility to work a full-time (40 hours minimum) flexible work scheduleThis role is a part of Humana's Driver Safety program and therefore requires and individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits.Must have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you workMust have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana At Home systems if 5Mx1MThis role is considered patient facing and is part of Humana At Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.Valid driver's license, car insurance, and access to an automobileAssociates working in the State of Florida will need ACHA Level II Background clearanceMust be passionate about contributing to an organization focused on continuously improving consumer experiencesPreferred Qualifications
BSN3-5 years of in home assessment and care coordination experienceExperience with health promotion, coaching and wellnessPrevious managed care experienceBilingual — English, SpanishCertification in Case ManagementMotivational Interviewing Certification and/or knowledgeAdditional Information
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About Us
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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