Care Navigator, Risk Management

Teladoc Health is a global, whole person care company made up of a diverse community of people dedicated to transforming the healthcare experience. As an employee, you’re empowered to show up every day as your most authentic self and be a part of something bigger – thriving both personally and professionally. Together, let’s empower people everywhere to live their healthiest lives.

The Opportunity

The Care Navigator, Risk Management works to provide proactive utilization management services for patients with high risk needs, inappropriate utilization of urgent or emergent care and complex medication needs. Providing excellent customer service, the Care Navigator will facilitate conversations between interdisciplinary Care Teams, which may include internal and external health care providers, such as Patient Navigators, Care Coordinators, Case Managers, Primary Care Physicians/Specialty Physicians and Hospital Systems. The Care Navigator will focus on providing high quality, cost effective, care coordination.

Responsibilities

• Review patient case with external health plan risk team and provide advice, direction, and support as needed
• Ensure adherence to established processes and compliance with privacy legislation and regulations with all parties encountered in the service delivery
• Analyze complex clinical situations and appropriately provide solutions
• Detect and manage possible health care risks
• Maintain thorough documentation of all patient encounters and complete reporting requirements according to organization standards
• Screen patient for eligibility for direct and support services and refers to needed services, such as health plan case management, external and internal referrals
• Establish and retain patient referral systems from care coordination systems
• Deliver on the Teladoc Corporate values
• Track patient information, schedules, files, and forms in a confidential manner
• Medication reconciliation
• Effectively manage special projects and other duties as assigned
• Conduct intake assessment, coordinate treatment plan, and conduct re-assessment of services to ensure coordinated, high-value, in-network care to optimize health outcomes
• Evaluate clinical data, implement action-oriented goals based on data interpretation and identify high risk patients
• Initiate outreach and missed appointment procedures, as necessary
• May meet with patient along with Patient Navigator after primary care physician appointments to review and update care plan

Candidate Profile

• Active RN, BSN or MSN, NP, LVN/LPN required
• Certified Case Manager preferred
• Proficient in technology including software programs such as Microsoft Office
• Strong customer service focus
• Effective time management skills
• Critical thinking skills and ability to interpret data
• Prior Care Coordinator experience preferred
• 1-3 years’ experience in a clinical environment required
• Ability to work independently and as part of a team
• Excellent written and verbal communication

The base salary range for this position is $80,000 - $90,000 . In addition to a base salary, this position is eligible for performance bonus, RSU’s, and benefits (subject to eligibility requirements) listed here: Teladoc Health Benefits 2023 T otal compensation is based on several factors including, but not limited to, type of position, location, education level, work experience, and certifications. This information is applicable for all full-time positions.