Disease Management Care Navigator

WVU Medicine; Cheat Lake (WV); On-site; USD 65,000 - 90,000; Full time

Job summary

West Virginia University Health System is seeking a Disease Management Coordinator to collaborate with patients and primary care providers to optimize health status. The role focuses on ambulatory management, risk stratification, care transitions, and coordinating services across the healthcare team.

The position requires an RN license with appropriate experience, strong communication, and a commitment to improving clinical and financial outcomes.

Qualifications

• Associate’s Degree in Nursing with 7 years of clinical experience, or a BSN with 5 years clinical experience.
• Current RN license in the state or multi-state licensure via eNLC.
• State and Federal background checks as required.
• Basic Life Support certification within 30 days of hire.

Responsibilities

• Ambulatory Utilization Management, Financial Management and Quality Screening for assigned patients.
• Identify population and risk stratify patients to prioritize needs and interventions.
• Coordinate discharge planning with inpatient and outpatient case management.
• Collaborate with physicians, patients and families to ensure safe transitions of care.
• Design individualized plans of care to coordinate services by the healthcare team.
• Coordinate with social services for financial assistance and resource management.
• Facilitate patient progression across continuum and transitional planning.
• Engage in clinical performance improvement and quality activities.
• Use data to drive decisions and plan improvements for fiscal, clinical and patient satisfaction metrics.
• Implement interventions based on risk stratification and evidence-based guidelines.
• Coordinate laboratory and diagnostic testing as needed.
• Evaluate lab results and utilization to monitor quality and efficiency.
• Contribute to development and revision of clinical pathways and tools.
• Educate the multidisciplinary team on pathways and managed care principles.
• Work with leadership to design centralized care models and drive process improvements.
• Monitor clinical and financial indicators and take action for continuous improvement.

Skills

Interpersonal communication

Negotiation

Adaptability

Independent judgment

Education

Associate’s Degree in Nursing

Bachelor’s Degree in Nursing

Job description

West Virginia University Health System is seeking a Disease Management Coordinator to collaborate with patients and primary care providers to optimize health status. The role focuses on ambulatory management, risk stratification, care transitions, and coordinating services across the healthcare team.

The position requires an RN license with appropriate experience, strong communication, and a commitment to improving clinical and financial outcomes.