Key skills
Collaboration
About this role
Role Overview
- Clinical triage to assess the severity of the patient’s health concerns using evidence-based protocols and algorithms in directing care to the right healthcare resource in a timely manner without compromising quality or safety
- Clinical navigation support includes but is not limited to: condition education, care options, and planning, care compliance, medication adherence, shared decision support, and care coordination
- Appropriately leverages input and direction from the Rightway provider to determine the best clinical options for those more complex patient health care needs.
- Accurately documents symptoms/complaints, nursing assessment, the guidance provided, and member/caller response.
- Acts in the best interest of the member by being a health advocate and supporter in the member’s healthcare journey.
- Proactive outreach engagement of high-risk, rising-risk, and gap in care members and assists them in making the necessary lifestyle and behavior changes.
- Coordinates the completion of screening services in high-risk patients by providing care management and adherence follow-up and care coordination support.
- Member’s trusted healthcare advisor, member experience and retention focus e.g. longitudinal care education, guidance, and support
- Develops effective collaboration and working relationships across the Navigation team and organization.
- Maintains a patient-centric, customer-driven professional attitude.
- Stay within the RN scope of practice by strictly following the protocols set by Clear Triage unless directed to do otherwise by a provider on the clinical team, then documenting appropriately when a change does occur.
Requirements
- RN, ADN, or BSN degree
- Holds an active RN license in a compact state and reside in a compact state
- Multiple RN state licenses desired CA, NY, MI, MA, MN
- 5+ years of clinical experience required, preferably in family medicine
- Triage nursing experience desired
- Care management / chronic condition support experience desired