CCM
NAMM California, a leader in the managed care industry, has an immediate opening for a Nurse Navigator in Ontario, CA.
RESPONSIBILITIES:
• Coordinates comprehensive health care services in a cost effective manner while assuring that quality is maintained for our senior members. A medical/social model will be used in the coordination of care.
• Using professional judgment and critical thinking skills will complete disease specific health appraisals/risk assessments
• Collaborates with attending physician, medical director, care partner, and team social worker to identify problems and develop a member specific plan of care
• Obtains plan benefits and established plan of care based on benefit design
• Channels health care services to contracted providers and seeks approval for coordination of out of network services when medically necessary
• Assists member and family in meeting their informational needs related to disease process, health plan, and opportunities for community support
• Develops and maintains in conjunction with the social worker local community resources by geographic area
• Participates in policy and procedure development, QI projects, and other job duties as necessary
SKILLS REQUIRED:
• Bachelor of Science in Nursing, Associate Degree in Nursing or Diploma Degree in Nursing
• California RN or LVN License
• Case Management Certification (preferred)
• Minimum 5 years acute clinical nursing experience
• Minimum 3 years case management or disease management experience
• Familiar with managed care regulations and Medicare
• Have acute or ambulatory care experience in managing cardiac, pulmonary, renal and diabetes disease states
• Demonstrated ability to develop innovative approaches in delivering health care and social services to assist member in maintaining independence or slow disease progress
• Intermediate/Advance computer applications, including Microsoft program
BENEFITS:
Competitive benefits include but are not limited to: Medical, Dental, Vision, Short and Long Term Disability, Life Insurance, Educational Reimbursement, Paid Holidays, 401K, and more!