Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
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This role is primarily remote; however, candidates must be located within Corpus Christi, TX to ensure accessibility to interface with members (home visits and telephonic) as needed to resolve cost and gap.
Job Summary: The ACO Nurse Navigator is a registered nurse who functions as a liaison between the ACO, the patient and the multidisciplinary healthcare team to assist in developing an optimal plan of care for transitioning Medicare patients, primarily those being discharged from hospital inpatient or emergency department services. The ACO Nurse Navigator assesses needs and coordinates resources within and outside the ACO (as approved by the ACO Director) to promote optimal health benefits and outcomes (both clinical and financial). The ACO Nurse Navigator will provide onsite review at the local UHS Acute facility, and establish rapport with local hospital case management, hospitalist, ER case management, and discharge planning staffs to expedite timely transitions of care and discharge of ACO patients.
This position requires a high frequency of contact with the very high risk ACO patient and their care givers for education of health promotion and self-care skills as well as facilitating compliance with the required quality measures for all ACO patients. A Patient Navigator will also ensure the coordination and communication of a patient's treatment plan and general status to all care givers during all transitions of care. This position requires advanced nursing knowledge and expertise to identify and implement improvement processes and the ability to direct and implement care coordination plans both in both in-patient and out-patient settings.
Benefit Highlights:
- Loan Forgiveness Program
- Challenging and rewarding work environment
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- SoFi Student Loan Refinancing Program
- Career development opportunities within UHS and its 300+ Subsidiaries! * More information is available on our Benefits Guest Website: benefits.uhsguest.com
About Universal Health Services:
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
QualificationsQualifications and Requirements:
- Graduation from an accredited nursing education program.
- Licensed by the State of Texas to practice as a registered nurse.
- Minimum of three years of Utilization Review/Case Management experience preferred.
- Recent (within past 3 years) working knowledge of Interqual criteria and Milliman Care Guidelines preferred.
- Minimum of three years in clinical medical/surgical nursing practice within a hospital setting.
- Ability to effectively communicate in English, both verbally and in writing.
- Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) Preferred
- Ability to document in different electronic health records as well as utilize Microsoft Products
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
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