RN Care Navigator & Case Manager

Position Summary

The RN Care Navigator/Case Manager is responsible for implementing, managing, and evaluating value-based care programs across the organization. This role involves strategic planning, program development, and performance management to improve patient outcomes and financial effectiveness. The RN Care Navigator/Case Manager works independently to address issues, providing guidance and training to clinical staff and facilitating patient outreach and care coordination.

They perform work under minimal supervision and handle complex issues and problems, referring only the most complex issues to higher-level staff. This role facilitates outreach efforts and care coordination for multiple aspects of value-based care programs. The RN Care Navigator/Case Manager possesses comprehensive knowledge and is a subject matter expert.

Primary Duties & Responsibilities

The duties and responsibilities listed herein represent the Essential Functions this position regularly and customarily performs. As such, this list is not intended to be exhaustive, and additional job-related duties that are similar in nature or logical extensions of the Essential Functions may also be performed.

• Program Management & Implementation: Directs, coordinates, and evaluates accountable and value-based care programs, including those related to Social Determinants of Health (SDOH), Transitional Care Management (TCM), and Annual Wellness Visits (AWV). Facilitates the implementation of new programs organization wide.

• Data Analysis & Reporting: Works with our data analysis staff, value-based team and insurance payers to aggregate, analyze, and interpret healthcare data from various sources (claims, medical records, etc.). Performs statistical analysis, writes queries, and generates reports to quantify program and provider performance. Uses data to suggest and track process improvements.

• Collaboration & Training: Serves as a subject matter expert, providing training and support to healthcare providers and clinical staff to ensure program compliance. Attends meetings and serves as point of contact for VBC partners.

• Outreach & Coordination: Leads and facilitates patient outreach efforts and care coordination for multiple value-based care programs.

• Strategic Planning: Participates in strategic planning for the development of new value-based care programs.

• Supervises CHC Value Based employee(s): Responsible for overseeing the day-to-day activities of their staff. Makes hiring and firing decisions, and performs typical supervisory duties such as timekeeping management, employee performance evaluations, disciplinary actions, employee recognition, company policy compliance, new hire onboarding and the like.

• Assists the Care Teams (provider, medical assistant, behavioral health provider and similar) by coordinating care to high risk and other patients to offer complete preventive care for all patients, whether patients of CHC or assigned by the insurance plan.

• Responsible for reporting data and other measures of progress made towards improvements aligning with Value Based Programs.

• Provides overall support to CHC Administration and completes special projects as needed.

• Develops and implements new initiatives within the nurse role at CHC, Inc. to improve patient care outcomes.

• Performs other related duties as assigned.

Qualifications & Education Requirements

• Bachelor’s degree in healthcare-related field

• Current Utah RN License in good standing

• Comprehensive knowledge of Value-Based care models and programs

• Strong computer literacy, data mining, analytical, and statistical skills

• Excellent communication and presentation skills

• Ability to work independently and manage complex projects with minimal supervision

• Experience in patient outreach and care coordination

• Bilingual capability (English/Spanish) is required

Preferred Qualifications

• Experience working with Value-Based Care initiatives desired

• Direct supervisory experience preferred

• Experience and/or knowledge of the medically underserved population helpful

Additional Notes Position Also Requires

• Prolonged periods sitting at a desk and working on a computer

• Prolonged periods of standing and bending

• Must be able to lift up to 15 pounds at times

• Typical setting is a clinical patient-facing position

• Typical setting is an office with moderate office noise level

• Regular and reliable on-site attendance

• Must have reliable transportation – Position requires frequent local travel across all CHC clinic locations

Pay: $65,000.00 - $80,000.00 per year

Benefits

• 401(k)

• Dental insurance

• Disability insurance

• Health insurance

• Life insurance

• Paid time off

• Vision insurance

Application Question(s)

• Do you have experience with Value-Based Care models?

Work Location: In person