Nurse Navigator Manager
- Phoenix, AZ
- Permanent
- Full-time
OverviewThe Nurse Navigator Manager is responsible for leading the Nurse Navigator (NN) team, driving strategic initiatives, and ensuring operational excellence. This role focuses on improving member engagement, cost savings, and clinical outcomes through effective team management, data analysis, and collaboration with internal and external stakeholders. The Nurse Navigator Manager will also oversee the development of workflows, ensure compliance with healthcare regulations, and act as a resource for clinical and operational excellence.
How you'll make an impactTeam Leadership and Development:
- Lead and manage the Nurse Navigator team, including performance evaluations, staffing, and professional development.
- Design and implement training programs to support staff development and ensure operational excellence.
- Provide mentorship and guidance to Nurse Navigators in areas such as healthcare navigation, claims resolution, and prior authorization processes.
- Oversee data analysis and reporting to support strategic initiatives by developing dashboards, metrics, and tracking processes to monitor key performance indicators (KPIs) such as member engagement, cost savings, task timeliness, and clinical outcomes.
- Collect and analyze data related to health outcomes, program participation, and satisfaction to assess program effectiveness and identify opportunities for improvement through data-driven recommendations.
- Build and maintain strong relationships with strategic partners to enhance clinical oversight, reporting capabilities, and operational efficiency.
- Collaborate with healthcare professionals, vendors, and other departments to integrate health and wellness initiatives.
- Lead initiatives to improve member engagement, preventative care, and cost savings through enhanced workflows, data visibility, and reporting capabilities.
- Advance strategies including: Site of Care Steerage, Rural vs. Metro cost analysis, Frequent ER User outreach, and others as deemed necessary.
- Develop and implement workflows for disease management, case management, and proactive outreach to high-risk members.
- Provide oversight for case management processes to ensure timely resolution and effective team support.
- Ensure appropriate utilization of services and effective case/cost management.
- Monitor and resolve escalated large claims issues and ensure appropriate treatment and billing.
- Manage a small caseload of high-priority or high-complexity cases to maintain clinical expertise and provide direct support for critical member needs.
- Act as a resource for the team by demonstrating best practices in handling complex cases and ensuring alignment with organizational goals.
- Ensure team compliance with healthcare regulations, including HIPAA, DOL, and other applicable standards.
- Maintain knowledge of healthcare billing and reimbursement processes, managed care guidelines, and national standards of practice.
- Stay updated on industry trends and advancements in case management, utilization management, and healthcare navigation.
- Active Registered Nurse (RN) license required.
- Bachelor of Science in Nursing (BSN) preferred.
- Minimum of 5+ years of experience in a Case Management or Utilization Management environment.
- Proven management experience, including leading teams and driving performance.
- Demonstrated ability to develop and execute a strategic vision to achieve organizational goals.
- Strong analytical skills with experience in tracking and reporting on KPIs.
- Knowledge of healthcare billing and reimbursement processes, managed care guidelines, and national standards of practice.
- Proficiency in using claims management software and productivity tools (e.g., Excel, PowerPoint, Microsoft Office Suite).
- Excellent communication and interpersonal skills to foster collaboration with internal teams and external partners.
- Experience in quality improvement activities and familiarity with reimbursement methodologies preferred.
- Strong communication skills to effectively present to groups and individuals.
- Critical thinking and problem-solving skills to assess health needs, identify risk factors, and develop appropriate interventions.
- Organizational and time management skills to manage multiple tasks and prioritize workload effectively.
- Flexibility and adaptability to adjust strategies based on the needs of individuals and groups.
- Collaboration and teamwork to work effectively with healthcare professionals, vendors, and community organizations.
- Professionalism and ethical conduct to adhere to legal standards and maintain confidentiality.
- Commitment to continued learning and adaptability to new software systems and technological advancements.
Compensation and benefitsWe offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:
- Medical/dental/vision plans, which start from day one!
- Life and accident insurance
- 401(K) and Roth options
- Tax-advantaged accounts (HSA, FSA)
- Educational expense reimbursement
- Paid parental leave
- Digital mental health services (Talkspace)
- Flexible work hours (availability varies by office and job function)
- Training programs
- Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
- Charitable matching gift program
- And more...