You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a Nurse Navigator to guide patient journeys within fixed-payment and risk-sharing models. The role focuses on ensuring clinical appropriateness and efficient care transitions, optimizing network partnerships, supporting preventative care, and managing resource allocation.
Responsibilities / Job Duties
- Oversee patient journeys within fixed-payment and risk-sharing models, ensuring clinical appropriateness and efficient transitions of care.
- Partner with medical service organizations to manage out-of-network repatriations and monitor length of stay.
- Implement interventions to reduce unnecessary emergency department visits and hospital readmissions.
- Utilize clinical criteria to determine medical necessity and optimize site-of-care decisions.
- Act as a central point of contact between acute care facilities, physician groups, and external service providers to streamline care delivery.
- Maintain rigorous documentation standards in compliance with NCQA, Medicare, and Medicaid protocols.
Minimum Education and Experience Qualification Requirements
Education
- Completion of a formal Case Management certification or specialized course.
- Valid AHA Basic Life Support (BLS) certification; must obtain local fire safety and crisis intervention/assault response certifications within 30 days of hire.
Qualifications
- Active Registered Nurse (RN) license in the state of California.
- At least 2 years of professional nursing experience in an acute care environment.
- Strong verbal and written communication skills for cross-functional collaboration.
- Comfortable working within a unionized labor setting.
Experience
- 2+ years of dedicated Case Management experience.
Skills
- Familiarity with utilization management and delegated risk workflows.
Schedule / Shift
Monday-Friday, 8am-5pm
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
