Clinical Care Navigator Job at Spring Health

Transitional Care Navigator

Addus Home Care / JourneyCare Hospice is seeking a Hospice Transitional Care Nav...

Location

United States , Naperville

Salary:

82000.00 - 93000.00 USD / Year

Arcadia Home Care and Staffing - an Addus family company

Expiration Date

Until further notice

Requirements

Bachelor’s degree in marketing, business administration, or other related fields is preferred
Licensed as a registered nurse in the state of practice, preferred
Minimum of two years relevant experience
Must possess the ability to make independent decisions when circumstances warrant
Must possess the ability to deal tactfully with patients, family members, visitors, agency personnel, and public
Must be knowledgeable of quality assessment and assurance procedures
Valid driver’s license and proof of insurance is required

Job Responsibility

Serve as hospice clinical consultant and educator, acting as extensions of hospital and physician care team
Review hospital clinical documentation/EMR/HCHB, engage with patients and providers to build clinical patient profiles and clinical-admission-assessments and identify decline patterns
Consult with hospital care teams by sharing clinical profiles and educating on hospice appropriateness
Identify attending and consulting providers associated with referred patients – to provide patient assessment, eligibility and discharge education and awareness
Collaborate with field sales representatives to schedule and conduct consultative meetings with external care teams
Initiate and maintain care team workflows for: Patient information / clinical assessment and documentation, Consultation / education planning and delivery, External and internal meetings and preparations
Identify trends, needs, and partnership opportunities for earlier hospice engagement
Foster effective and trusted relationships with external care teams to improve patient outcomes and enhance end-of-life satisfaction
Communicate clearly and consistently with hospital leadership and care coordination teams
Effectively organize, track and prioritize high-value patient comprehensive reviews

What we offer

Great culture and team atmosphere
Comprehensive benefits (medical, dental, vision, life/AD&D, disability), effective on the first of the month
401(k) retirement plan with a generous company match
Generous time off accruals
Paid holidays
Mileage reimbursement
Tuition Reimbursement
Employee Referral Program
Merit Increases
Employee Discount Programs

Fulltime

Clinical Care Coordinator

Clinical Care Coordinators are responsible for ensuring facilities are scheduled...

Location

United States , Overland Park

Salary:

Not provided

Aria Care Partners

Expiration Date

Until further notice

Requirements

Associate or bachelor’s degree preferred – equivalent work experience accepted
Problem solving—the individual identifies and resolves problems in a timely manner
Planning/organizing—the individual prioritizes and plans work activities and uses time efficiently
Quality control/Attention to detail—the individual demonstrates accuracy and thoroughness
monitors own work to ensure quality and applies feedback to improve performance
Adaptability—the individual adapts to changes in the work environment, manages competing demands, and can deal with frequent change, delays, or unexpected events
Dependability—the individual is consistently at work and on time, follows instructions, responds to management direction, and solicits feedback to improve performance
Computer skills – considerable knowledge of computer systems/programs including Excel
Ability to quickly learn, adapt, and navigate new or complex software systems
Ability to work in and utilize multiple systems concurrently

Job Responsibility

Track provider availability and create and communicate monthly schedules for providers
Prepare patient lists for scheduled visits using available reports, create notifications and send to Customer Support Specialist 2 weeks prior to scheduled visit date
Maximize use of clinical days and schedule work efficiently
Manage requests from Customer Support Specialist to ensure residents are seen at upcoming visits in a timely manner and according to clinical need
Remain accessible to Providers throughout day to provide support while providers are in clinic
Use metrics provided to increase efficiency in clinical day and service delivery
Perform other duties as necessary.

What we offer

PTO and Paid Holidays for FT Employees
401k Retirement Plan with a Company Match
Insurance programs including medical, dental, vision, company match for your HSA, FSA, company-paid EAP, and life and disability insurance, and more.

Fulltime

Nurse Practitioner, Transitional Care

The Advanced Practice Provider, Transitions delivers high-touch, high-quality ca...

Location

United States , Indianapolis

Salary:

Not provided

CVS Health

Expiration Date

July 21, 2026

Requirements

Have an active, non-probationary state medical license, including US work authorization, if applicable
1+ years APN experience, preferably with a Medicare population
Experience in home-based care (as RN or APP) preferred
Flexibility to travel throughout service area
Electronic Medical Record experience
Computer skills: Ability to quickly navigate and use multiple computer programs to include, but not limited to: Gmail, MS Word or Google Docs, Excel or Google Sheets, etc.
Additional language proficiency in Spanish, Polish, Russian, or other languages spoken within the communities we serve preferred but not required

Job Responsibility

Provide post-discharge support according to defined pathways within the patient's home
Develop care plans and individualize goals of care with patient, their families, and their providers
Optimize and monitor clinical status, identify and address gaps in care, reconcile medications and address adherence challenges
Collaborate with Transitional Care Managers, home health, social workers, hospitals, SNFs, and specialists
Structure and prioritize scheduling based on clinical complexity for both new and routine patients
Recognize, diagnose, and manage both acute and chronic medical conditions in order to prevent destabilization and readmissions
Provide after-hours and weekend call support, shared with other in-state providers
Facilitate and conduct goals of care and advance care planning discussions with patients and families
Assess and evaluate family/caregiver needs and limitations
Teach patients, caregivers, and others about their health conditions

What we offer

Mission-focused career impacting change and measurably improving health outcomes for Medicare patients
Paid vacation, sick time, and investment/retirement 401K match options
Health insurance, vision, and dental benefits
Opportunities for leadership development and continuing education stipends
New centers and flexible work environments
Opportunities for high levels of responsibility and rapid advancement
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules

Fulltime

Transitional Care Advanced Practice Provider (APP)

The Advanced Practice Provider, Transitions delivers high-touch, high-quality ca...

Location

United States , St. Louis, MO

Salary:

78000.00 - 168714.00 USD / Year

CVS Health

Expiration Date

March 16, 2026

Requirements

Have an active, non-probationary state medical license, including US work authorization, if applicable
1+ years APN experience, preferably with a Medicare population
Experience in home-based care (as RN or APP) preferred
Flexibility to travel throughout service area
Electronic Medical Record experience
Computer skills: Ability to quickly navigate and use multiple computer programs to include, but not limited to: Gmail, MS Word or Google Docs, Excel or Google Sheets, etc.
Additional language proficiency in Spanish, Polish, Russian, or other languages spoken within the communities we serve preferred but not required

Job Responsibility

Provide post-discharge support according to defined pathways within the patient's home
Develop care plans and individualize goals of care with patient, their families, and their providers
Optimize and monitor clinical status, identify and address gaps in care, reconcile medications and address adherence challenges
Collaborate with Transitional Care Managers, home health, social workers, hospitals, SNFs, and specialists
Structure and prioritize scheduling based on clinical complexity for both new and routine patients
Recognize, diagnose, and manage both acute and chronic medical conditions in order to prevent destabilization and readmissions
Provide after-hours and weekend call support, shared with other in state providers
Facilitate and conduct goals of care and advance care planning discussions with patients and families
Assess and evaluate family / caregiver needs and limitations
Teach patients, caregivers, and others about their health conditions

What we offer

Mission-focused career impacting change and measurably improving health outcomes for Medicare patients
Paid vacation, sick time, and investment/retirement 401K match options
Health insurance, vision, and dental benefits
Opportunities for leadership development and continuing education stipends
New centers and flexible work environments
Opportunities for high levels of responsibility and rapid advancement

Fulltime

Health Navigator

The Health Navigator will understand the requirements and intent of the Delaware...

Location

United States , Dover; Newark; Wilmington

Salary:

27.00 - 31.00 USD / Hour

Aledade, Inc.

Expiration Date

Until further notice

Requirements

Familiarity with the healthcare community we are serving or commitment to learn and understand through networking, community assessment, etc.
Valid Delaware driver’s license required, excellent driving record and have reliable transportation
1-3 yrs. of healthcare experience
Ability to assist the interdisciplinary care team to collaboratively plan, prioritize, implement, and evaluate individual community members’ plans
Experience working in a medical practice or healthcare setting is preferred
Experience & comfort using technologies such as a computer, telephone, and various types of electronic health record (EHR) platforms to document patient interactions and schedule patients for appointments
Medical Terminology certification is preferred
Must possess strong organizational skills
Ability to work independently
Proficient with Microsoft and Google applications

Job Responsibility

Conduct direct telephonic outreach to health plan members based on outreach initiatives
Completes social determinants of health screenings and facilitates access to community and/or health plan resources such as food, housing, mobility, energy assistance or other governmental programs in a closed loop referral process to ensure health plan members connection to services
Engage health plan members in obtaining preventative screening and close care gaps
Coordinates and documents including comprehensive tracking of health plan members’ adherence in relation to appointments, health screenings, care plan objectives, non-clinical assessments, encounters, service plans, and outcomes achieved in an effective manner
Under the direction of the Senior Manager, Care Management and in collaboration with the primary care provider, assists health plan members in understanding care plans and instructions and provides support in developing healthier habits and proper use of the emergency room and providing information for alternatives
Builds and maintains positive collaborative relationships with health plan members and caregivers, Providers, interdisciplinary care team members, and health plan representatives to deploy health engagement strategies and interventions

What we offer

Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options

Fulltime

Supervisor Care Management Population Health

The Supervisor Care Management Population Health will support the Director of Ca...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Graduate of an accredited Registered Nursing program
Excellent computer skills needed
Experience with word processing/spreadsheets, including Excel
Excellent verbal and written skills
Minimum of five years clinical experience
Three years Case Management experience preferred
Active RN Licensure in state of employment
CCM preferred

Job Responsibility

Supports leadership with the selection, training, development, appraisal, work assignments, performance management, staffing, and productivity of Associates within Population Health Care Management
Understands and supports “Triple Aim” objectives of Population Health and promotes these objectives in concert with organizational Core Values when supervising and leading the teams
Provides formal, structured orientation/training process for new Associates with regular opportunity for feedback and assessment of competency upon completion
Collaborates with Primary Care Clinics to implement Care Coordination and/or Nurse Navigation for value-based contracts
has experience with ambulatory clinic workflow with ability to partner and troubleshoot with ambulatory clinical team to develop and refine operational workflows within the practice and specific EHR
familiar with order sets, appointment templates, scheduling of procedures, and pre-authorization
Capable of learning to navigate EHRs to thoroughly research the patient medical record to locate and identify documentation for completion of quality measures
has or can develop expertise regarding clinical knowledge of quality measures with ability to interpret definitions regarding inclusions and exclusions
Collaborates with Primary Care Clinical Team to develop and test operational workflows within specific EHR to communicate/document appropriate Home Health Case Conference information and recertification recommendations to the clinician
Ability to develop collaborative relationships with Home Health Agencies to coordinate 485 plan of care process and Case Conference scheduling

Fulltime

New

Care Navigator - Substance Use Disorder

This position is a full-time, remote position that reports directly to the Clini...

Location

Salary:

33.33 - 42.31 USD / Hour

Spring Health

Expiration Date

Until further notice

Requirements

Mental Health Licensure required: LCSW, LMFT, LPC with 2+ years of experience in substance use disorder (SUD) clinical care
Proficiency in motivational interviewing, triage, ASAM criteria and various levels of care and best practices for SUD
Strong listening, written, and verbal communication skills
Ability to work effectively with diverse populations and a commitment to embracing diversity and inclusion
Motivated to provide a high-touch, supportive experience for clients
Comfortable using various computer platforms, learning new systems, and efficiently handling tech-related tasks
Capable of managing multiple tasks and switching contexts efficiently
Embraces new challenges and opportunities for development, continuously seeking to enhance professional skills and contribute to organizational growth

Job Responsibility

Conduct outbound calls and follow-ups with individuals interested in or referred for substance use disorder treatment, demonstrating advanced skills in engagement and relationship-building
Engage with clients using advanced clinical techniques to assess their needs, provide comprehensive information about treatment options, and make informed recommendations for care
Independently coordinate appointments, referrals, and follow-up care, ensuring a seamless and high-quality care experience for clients, including managing complex cases
Apply advanced psycho-education, motivational interviewing, and evidence-based practices to support clients in setting and achieving their goals for reducing substance use and enhancing recovery
Utilize in-depth knowledge of substance use disorders, ASAM levels of care, and various SUD treatments (e.g., contingency management, MAT, detox) to provide expert guidance and support
Provide sophisticated in-the-moment support, crisis intervention, and safety planning for clients facing urgent or high-risk situations, utilizing advanced clinical judgment
Maintain detailed and accurate records within an EHR and other systems, ensuring comprehensive documentation and tracking of client progress and interventions
Identify and resolve complex issues that may disrupt care, employing advanced problem-solving skills and resourcefulness
Collaborate effectively with multi-disciplinary teams, including care support, provider operations, and benefits/billing, to ensure integrated and efficient client care
Actively participate in staff meetings, case consultations, and ongoing training to continuously enhance clinical skills and knowledge

What we offer

Health, Dental, Vision benefits start on your first day
Individual One Medical account valued at $199/year per user
HSA and FSA plans available
Employer sponsored 401(k) match of up to 2%
Yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents
Generous paid time off, 10 sick days, 12 paid holidays throughout the year, and a 1 month sabbatical leave granted at your 4 year anniversary
Parental leave up to 18 weeks
Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses
Access to Wellhub, an on-demand virtual benefit that provides wellbeing coaching, and budget management
Up to $1,000 Professional Development Reimbursement a year

Fulltime

Rare Condition Manager

To support high-quality, cost-effective care by coordinating services for member...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge
Practice interpersonal and active listening skills to achieve customer satisfaction
Interpret and translate policies, procedures, programs, and guidelines

Job Responsibility

Perform assessments, condition management education, training, and other clinically-based activities to coordinate care among providers, members, and family to implement the care plan
Make and answer a diverse and high volume of condition management-related member calls on a daily basis
Identify holistic member needs considering whole-person health, to include condition-specific needs, behavioral health needs, and social drivers of health needs
Analyze medical records, claims data, and other information sources
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, BCBSAZ programs, provider networks, etc
Present status reports on cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy

Fulltime

Clinical Care Navigator

Spring Health

Location:

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
February 18, 2026

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