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Highmark Health

Health insurance plans and wellness resources

RN Nurse Navigator

Medical, Clinical & VeterinaryUpdated on Nov 13
Full-timePennsylvania, USA$34.29 - $54.25

About the Job

Requirements

  • Current Pennsylvania RN licensure or current multi-state licensure through the enhanced Nurse Licensure Compact is required.
  • One to three years of nursing experience in the specialty is required.
  • Current American Heart Association CPR is required.
  • Act 34 Criminal Background Clearance Certificate is required.
  • Act 33 Child Abuse Clearance Certificate is required.
  • Act 73 FBI Fingerprinting Criminal Background Clearance Certificate is required.
  • A valid Pennsylvania driver's license may be required.
  • Older Adults Protective Services Act clearance may be required depending on location.

Responsibilities

  • Serve as the consistent point of contact for referring physicians, patients, caregivers, families, and the community.
  • Facilitate patient flow by coordinating appointments and assisting patients in accessing clinical and supportive care services within the Network.
  • Coordinate all aspects of care for adult patients within a specialized disease state in collaboration with the multidisciplinary team to ensure quality and comprehensive services.
  • Identify community needs and provide education, screening, support, referrals, care coordination, and other necessary assistance.
  • Oversee community outreach, high-risk populations, and disease-specific sites to establish and sustain working relationships within the network, including with the health plan, physicians, office staff, social services staff, financial counselors, and dieticians.
  • Educate patients and coordinate care regarding diagnoses, treatment options, courses of treatment, clinical trial information, and available resources.
  • Work with the health care team to ensure safe handoffs and coordinate care between facilities and between inpatient and outpatient settings.
  • Work with High-Risk Care Teams to reduce readmissions.
  • May work with or assist Registry staff with data collection, patient outcomes, and updates to care delivery models.
  • Coordinate appointments across the multidisciplinary team, including physicians, consults, and supportive care services, and accompany patients to appointments as needed.
  • Ensure medication adherence issues are addressed.
  • Work with AHN physician offices and facilities to identify at-risk patients and help facilitate appropriate screening processes.
  • Trend data and outcomes established for the navigation program and identify gaps to improve patient care across the continuum.
  • Develop or attend an existing clinical care conference to report active patients to the multidisciplinary team.
  • May identify bereavement needs of families and develop a plan of care.
  • Comply with HIPAA, company privacy and information security policies, the Code of Business Conduct, applicable laws and regulations, and company training requirements.

Desired Qualifications

  • A Bachelor's Degree in Nursing is preferred.
  • Certification in the area of expertise is preferred.
  • Prior Nurse Navigation experience is preferred.
  • Case Management RN experience is preferred.
  • Home Health RN experience is preferred.
  • Clinic RN experience is preferred.

About the Company

Highmark Health

Health insurance plans and wellness resources

Highmark Health provides health insurance plans in Pennsylvania, Delaware, and West Virginia for individuals, families, businesses, and Medicare beneficiaries. Plans are funded by premiums and government reimbursements, and cover services like doctor visits, hospital stays, prescription drugs, and preventive care, plus member tools such as symptom checkers, cost and coverage details, and OTC rapid test reimbursements. It differentiates itself through active community involvement and sustainability efforts, alongside a large, diverse member base and Medicare compatibility that influence plan design. The goal is to improve community health by offering comprehensive coverage and supportive health resources while operating in a responsible and sustainable way.

Company size
5,001-10,000
Company stage
Grant
Total funding
$29.6M
Headquarters
Pittsburgh, PA
Founded
1996

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