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8 Nurse Navigator jobs match your search criteria.

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Job Description: HEDIS Nurse Abstractor (RN) HEDIS Nurse Abstractor (RN) Location: Newark, NJ Salary:  Experience: 1. year(s) Job Type: Temporary / Consulting Job ID: U1012423       About the Opportunity A premier managed care company is looking for a HEDIS Registered or Practical Nurse to join their team in a remote HEDIS  Abstractor role. This is a fantastic opportunity for a qualified and self-motivated Nurse  to continue their career with one the of the most reputable insurance companies nationwide. Apply today! Company Description Managed Care Company Job Description The HEDIS Nurse Abstractor (RN): Performs over-reads on HEDIS records Reviews and abstracts paper and electronic medical records utilizing NCQA HEDIS Technical specifications to optimize Plan HEDIS scores Performs complete and accurate data entry of qualifying services and results into HEDIS electronic database software Identifies and communicates patterns of missing documentation for the assessment of additional records Routes all exclusions and complex issues to the Quality Improvement Nurse Meets or exceeds accuracy standard of 95 percent and turn around standard of 24-48 hours for medical record review and data entry Attends department meetings and delivers hard copy records weekly Successfully completes Medical Record Reviewer training and Inter Rater Reliability Testing at 100 percent Successfully completes HEDIS software training and uses software correctly to facilitate accurate reporting and ongoing progress of the annual HEDIS project Required Skills Active Registered or Practical Nurse license Strong medical skills and knowledge Graduate of an accredited school of nursing Demonstrated computer skills and analysis capabilities in order to navigate CPT4 code and ICD9/10 DX based on HEDIS Technical Specification requirements Understanding of codes for services based on diagnosis and procedure Research and detail-oriented with the tenacity to find claim-specific data for a specific measure within a given period of time Knowledge of Microsoft office Effective written, oral, and interpersonal communication skills Basic Excel skills Ability to type 30-40 WPM Prior HEDIS   Desired Skills Experience working in various EMR systems

Job Description: Home Health Nurse (RN) Home Health Nurse (RN) Location: New Haven County, CT Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1009769       About the Opportunity A recognized healthcare company located in New Haven County, CT is actively seeking a compassionate and empathetic Registered Nurse, with a strong Home Health background, for a promising opportunity on their staff. In this role, the Home Health Nurse provides, coordinates, and directs the provision of home nursing care according to physician's orders based on agency policies and procedures, through the competent application of the nursing process. Company Description Healthcare Company Job Description The Nurse (RN) will: Assesses and evaluate patient's /client's status Regularly re-evaluates patient/client needs  Reviews and revises the plan of care as necessary Specifies the assignment for Home health Aides Supervises the HHA every 14 days Reviews and revises assignment plan as necessary Supervises LP(V)Ns  Complies with accepted professional standards and principles Follows all rules/regulations in home care as mandated by state/federal regulations Required Skills Current and unencumbered Connecticut State license to practice as a Registered Nurse 2-3+ years of nursing experience Current CPR certification Able to assess patient status and identify requirements relative to age specific needs Familiar with general use and functions of the computer, such as, user names and password concepts; internet; e-mail; navigation of computer desktop, including starting programs, using files, and windows, effectively use navigation buttons and tool bars; ability to self-manage online HR services and online training programs.

Job Description: Staff Educator (RN) Staff Educator (RN) Location: Brooklyn, NY Salary: $90,000-$105,000 Experience: 3.0 year(s) Job Type: Full-Time Job ID: J136182       About the Opportunity A healthcare facility in New York City is actively seeking a licensed Registered Nurse (RN) for a promising Staff Educator position with their growing team. Reporting to the Manager of Staff Development, the Staff Educator (RN) will be responsible for conducting orientation and ongoing education for clinical staff hired. Apply today! Company Description Healthcare Facility Job Description The Staff Educator (RN) will be responsible for: Overall processes related to a field visit All aspects of care in the home setting Documentation and navigation of the electronic records Clearance of Nurses (RNs) in the field and clinical topics commonly seen in the Home Health setting Required Skills 3+ years of progressive job related experience, including Field Visits and Coordination of Care Bachelor's Degree in Nursing Valid NYS Registered Nurse (RN) license Computer savvy Solid assessment and documentation skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Master's Degree in Nursing Previous Education experience Oasis certification

Job Description: HEDIS Abstractor Nurse HEDIS Abstractor Nurse Location: Iselin, NJ Salary:  Experience: 1. year(s) Job Type: Temporary / Consulting Job ID: U1014180       About the Opportunity A widely recognized health benefits company in Iselin, NJ is actively seeking a self-motivated and diligent Nurse to join their staff in a HEDIS Abstractor role. In this role, the HEDIS Abstractor Nurse will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific database. Apply today! Company Description Health Benefits Company Job Description The HEDIS Abstractor Nurse (RN) will: Work under the supervision of internal staff and designated lead in order to achieve goals and keep the project moving Handle a high volume of telephonic interaction with provider offices Follow up on requested medical records with providers Adhere to measured productivity requirements, module testing and at times retesting to meet minimum requirements Perform research on internal claims systems Required Skills Active RN, LPN, or LVN Graduate of an accredited school of nursing Chart audit experience Ability to navigate CPT4 code and ICD9 and ICD10 DX based on HEDIS Technical Specification requirements Understanding of codes for services based on diagnosis and procedure Ability to decipher and abstract specific clinical data from the medical record Intermediate knowledge of Excel and Word Desired Skills 1 year of HEDIS abstraction/over-read experience

Job Description: Case Manager (RN) Case Manager (RN) Location: New York, NY Salary: $62,000-$77,000 Experience: 3.0 year(s) Job Type: Full-Time Job ID: J131997       About the Opportunity A healthcare organization in New York City is actively seeking a licensed Registered Nurse (RN) for a rewarding Case Manager role with their medical staff. In this position, the Case Manager (RN) will be responsible for using industry criteria, benefit plan design, clinical knowledge, and critical thinking to assess, plan and provide the ongoing coordination and management of service delivery through an integrated case management approach with utilization review and case management activities. Company Description Healthcare Organization Job Description The Case Manager (RN) will: Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services Provide an integrated holistic case management telephonic approach to those with chronic medical and behavioral health conditions with the goal of reducing the clinical gap between inpatient and outpatient services and potentially prevent hospital re-admissions Authorize vendor services using clinically proven criteria to make consistent care decisions Assist with discharge planning and care coordination to ensure optimal outcomes Maintain accurate record of case management assessment and intervention including benefit and cost analysis for data collection and trending Promote active involvement and initiative to members regarding their health care management and navigating health care delivery systems in order to preserve benefit resources Communicate effectively with members, physicians, and providers; facilitate, advocate, and educate on the disease process Abide by and support the care management programs in order to ensure quality and efficient clinical operations Perform additional duties and projects as assigned by management Required Skills 2+ years of Medical and Surgical Clinical experience; 1+ year of Case Management, Utilization Review, or Disease Management experience NYS Registered Nurse (RN) license Strong experience with discharge planning Strong knowledge with standard utilization criteria (Milliman, Interqual), Medicare and Medicaid coverage guidelines, health claims processing, medical coding and interpreting provider contracts Solid problem-solving, clinical assessment, and care planning skills Patient oriented Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized $ Desired Skills ASN / BSN

Job Description: Labor and Delivery Clinical Nurse Leader / Educator Labor and Delivery Clinical Nurse Leader / Educator Location: Brooklyn, NY Salary: $95,000-$110,000 Experience: 5.0 year(s) Job Type: Full-Time Job ID: J136295       About the Opportunity The Labor and Delivery Department of a recognized healthcare facility is actively seeking a licensed Registered Nurse (RN) to join their growing staff as a Clinical Nurse Leader / Educator. In this role, the Labor and Delivery Clinical Nurse Leader / Educator (RN) will be responsible for developing, coordinating, implementing and evaluating educational programs and services to meet the learning needs of Obstetrical Registered Nurses and Nursing support staff. Apply today! Company Description Healthcare Facility Job Description The Labor and Delivery Clinical Nurse Leader / Educator (RN) will be responsible for: Cultivating an environment that supports continued professional development Helping to establish practice standards for clinical nursing units Participating in ongoing performance improvement initiatives Required Skills 2+ years of prior Labor and Delivery Clinical experience; 2+ years of Education and/or Leadership experience Master's Degree in Nursing NYS Registered Nurse (RN) Certification as a RNC-OB and C-EFM Registered Nurse BCLS certification Member of AWHONN Association of Women's Health, Obstetric and Neonatal Nurse organization Working knowledge of Electronic Medical Record navigation Microsoft Office/Suite proficient Solid assessment and documentation skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Master's Degree in Nursing Education ACLS certification

Job Description: In-Field Navigator In-Field Navigator Location: New York, NY Salary:  Experience: 2. year(s) Job Type: Full-Time Job ID: J137406       About the Opportunity A New York City-based healthcare organization is currently looking to add a licensed medical professional to their staff as their new In-Field Navigator. In this role, the In-Field Navigator will be responsible for providing educational support and training to Physicians, staff and Pharmacists at their practice locations and in the community to ensure compliance with a focus on HEDIS, QARR and Medicare Advantage Star measures and quality improvement activities. Apply today! Company Description Healthcare Organization Job Description The In-Field Navigator will be responsible for: Participating in initiatives across a broad array of clinical measures and health improvement activities Completing member outreach and education, as needed, to ensure members receive appropriate services Providing support and training to physicians on proper coding and medical record documentation practices to support improvement in quality metrics Facilitating referrals to Case Management to assist with the Transition of Care issues and customer service to address member concerns Required Skills 2+ years of related work experience Bachelor's Degree in a related field NYS Health Educator, Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), and/or Foreign Medical Graduate (FMG) Experience with Medical Record review working on HEDIS / QARR in a Healthcare and/or Managed Care setting Computer savvy Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Prior Quality Improvement experience in a Healthcare and/or Managed Care setting

Job Description: Patient Care Advocate Patient Care Advocate Location: Miami, FL Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1011421       About the Opportunity A widely recognized managed care organization located in Miami is actively seeking a self-motivated and patient-oriented healthcare professional for a promising opportunity on their staff as a Patient Care Advocate. In this role, the Patient Care Advocate works with members and providers to close care gaps, ensures barriers to care are removed, and improves the overall member and provider experience through outreach and face-to-face interaction with members and providers at large IPA and/or group practices. Company Description Managed Care Organization Job Description The Patient Care Advocate:  Acts as a liaison and member advocate between the member/family, physician and facilities/agencies Assesses provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations Schedules doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider's office Conducts face-to-face education with the member and their family, in the provider's office, about care gaps identified, and barriers to care Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements Arranges transportation for members as needed Arranges follow-up appointments for member as needed Documents all actions taken regarding contact related to member Interacts with other departments including customer service to resolve member issues   Required Skills Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field 2+ years of experience in HEDIS, quality improvement, member outreach and/or health coaching in a managed care environment Microsoft Word Proficient in Microsoft Office such as Word, Excel and Outlook Ability to use and navigate health service management systems Healthcare Management Systems experience Ability to create, review and interpret treatment plans Ability to effectively present information and respond to questions from families, members, and providers Ability to multitask Ability to work in a fast-paced environment with changing priorities Knowledge of healthcare delivery Knowledge of community, state and federal laws and resources Desired Skills 2+ years of experience in Social work Other Experience in managed care One of the following: Licensed Clinical Social Worker (LCSW), Licensed Social Worker (LSW), Certified Social Worker (C-SW), Certified Social Worker in Health Care (C-SWHC), Licensed Clinical Social Worker Certified (LCSW-C) Bilingual, English and Spanish

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Are you a licensed BSN with excellent interpersonal skills and a desire to help patients? Nurse navigator jobs may be right up your alley!

As a nurse navigator, you will guide patients and their families through the healthcare experience. Working with all patient populations, you prepare patients for care by explaining medical treatments, explaining their medical coverage and ensuring they receive quality care. You will work with your patients throughout their stay, and even follow up with them after discharge to check on their recovery.

Like other nursing positions, nurse navigators must stay current with the latest medical advances, and are subject to the same CE regulations as other nurses in their state. Before making the move to nurse navigator jobs, you should be prepared to answer a lot of health insurance questions. A thorough, up-to-date knowledge of coverage types and options is necessary to fully help patients understand their medical choices. Although these positions are highly independent, nurse navigators frequently work with other healthcare providers to make sure patients receive the appropriate treatment.

Does this sound like the career move for you? Then check out open nurse navigator positions here at ADVANCE Healthcare Jobs! See something that would be perfect for a friend or colleague, but isn’t a great fit for you? Sign in with your Facebook or LinkedIn account to share jobs with them instantly!