Advanced Plan for Health Logo
 

Job Description

Position

Registered Nurse (R.N.) – Work-at-Home Telephonic Medical Management Nurse Navigator / Health Coach

About Advanced Plan for Health

Advanced Plan for Health, LLC (APH) is an advanced and predictive analytics firm based in Westlake, Texas (a suburb of Dallas). Founded in 2004, our firm was built to support companies such as employers, hospitals, health systems, brokers, third party administrators in a better understanding of the current state and potential future state of the health of their populations.

At the heart of what we do is our passionate people powered by our proprietary advanced and predictive analytics platform called Poindexter. Through this platform, we help our clients to identify those people in their populations who are in need of support, education and guidance due to chronic conditions and co-morbidities, medication risks, gaps in care, events such as hospital admissions and readmissions and more.

Our powerful analytics platform predicts likelihood of hospital admissions, ER utilization, heart attacks, strokes, chronic kidney disease, and much more to support clinical intervention and outreach as early as possible to help reduce future risk and costs to the health plan and the individuals impacted.

More and more often, our clients are leaning on us to support outreach to identified members in need of navigation, coaching and case management support. This Contract Telephonic Medical Management Nurse Navigator / Health Coach role will be integral in helping us to fulfill that client need and do more to help people get the clinical support they need to live healthier and more fulfilling lives.

Email us today to learn more about our team’s efforts that are making a significant and measurable difference in the lives of so many.
Submit your resume to: HR@mypoindexter.com.

About This Opportunity

Become a part of the team at Advanced Plan for Health where you will be able to use your clinical experience to work with members / patients and providers in an environment where your knowledge will be appreciated, and you will make a measurable difference. Give yourself the opportunity to truly focus on your patients 1-on-1, and provide them the coaching and guidance they need to make better health and well-being decisions.

As a Telephonic Medical Management Nurse Navigator / Health Coach, you’ll be joining a team of talented, expert healthcare professionals who are passionate about improving the healthcare experiences for people of all ages on behalf of our business clients. You’ll feel proud of the work you do, knowing you’re truly helping others navigate their healthcare decisions so they may experience better outcomes.

This important role will involve working with a team environment to provide case, utilization, disease / chronic condition, and wellness management services for health benefit plan clients of Advanced Plan for Health.  The selected nurse will provide these services by interacting with others on the APH team, plan members / patients, physicians and other providers.  The role will primarily involve outbound calling to identified members, and members will be able to call-back as needed.

This is a work from home opportunity. 

Under the experienced leadership and guidance of APH’s Vice President of Clinical Operations, the Medical Management Nurse Navigator / Health Coach will perform duties such as (but not limited to) the following in support of APH’s clients:

  1. Establish effective rapport with clients, plan members (members / patients), physicians and other providers / facilities, and their designated staff.
     
  2. Use effective relationship management, coordination of services, resource management, education, influence, member / patient advocacy, and related interventions.
     
  3. Interact with providers and plan members in case management medical management activities to provide the most efficient and effective service.
     
  4. Monitor and evaluate the effects of disease, utilization, wellness and case management on the patient population.
     
  5. Identify appropriate alternative and non-traditional resources and demonstrate creativity in managing each case.
     
  6. Create outcomes management focus by interdisciplinary analysis of specific clinical, financial and satisfaction elements for the patient population.
     
  7. Review pre-service notification requests for medical necessity services and / or provider network exceptions, referring to manager those cases that require additional expertise or knowledge of the client’s benefit plan and network.
     
  8. Review clinical information for concurrent reviews, extending the length of stay for inpatients as appropriate, or referrals to other network providers.
     
  9. Use standard tools, databases and methodologies to support the health benefit program and provide leadership in managing cases, events and diseases that are determined to be targeted priorities.
     
  10. Maintain accurate records of all communications and interventions and provide timely verbal and written reports as directed within the APH Poindexter platform.
     
  11. In partnership with the APH leadership and analytics resources, assist in the analysis of demographics, utilization and reimbursement for the health plan.  
     
  12. In partnership with the APH leadership and analytics resources, assist in making recommendations based on data analysis for benefit structure, pharmacy formulary, deductibles, co-pays, out of pocket etc. to APH clinical manager or account manager, as appropriate.
     

Qualifications

Education

Preferred - Bachelor’s Degree in Nursing or higher. Certification in Case Management (CCM) a plus.

Experience

Required - Three to five years of professional nursing experience with a minimum of three years of clinical case and / or medical management experience as a Registered Nurse.  

Required - Ability to adeptly utilize a computer in order to review patient / member information as well as to enter and maintain accurate records of all communications and interventions and provide timely verbal and written reports as directed within the APH Poindexter platform. Training and ongoing support will be provided in the Poindexter platform.

Preferred – Experience in utilization management and pre-service review of requested inpatient and outpatient services and working with providers.

Licenses, Certifications, Insurance

Requirements

  • Must apply for and maintain in good standing a multistate R.N. license (Compact State)
    • Must provide proof of licensure upon hire.

Hours, Office and Equipment Requirements

  • Working time will largely be during normal working days and hours of Monday through Friday from 9 a.m. to 6 p.m. Eastern Time, but will require flexibility in order to adequately cover the times needed to reach members and patients.
  • Must provide your own office that meets privacy requirements E.g. a private workspace in an office or room with a desk that has a door that may be closed to separate your workspace from the remainder of your home.
  • Must provide an internet connection, computer, faxing capability, printer and phone.
  • APH will provide access to toll-free numbers, an APH email and training in the processes for outbound and inbound call handling. 

 

Email us today to learn more about our team’s efforts that are making a significant and measurable difference in the lives of so many. Submit your resume to: HR@mypoindexter.com.