Clinical Guide, Population Health RN

With Rightway as your healthcare benefits partner, you don't have to compromise on employee health, happiness, or your company's results. We bring together the power of trusted clinicians and smart technology to help members make better decisions, get care faster, and spend less. By reimagining pharmacy benefits and care navigation, we give employers and their people a simpler, more transparent healthcare experience. One that lowers costs, improves outcomes, and restores trust.

Under the general supervision of the Sr. Clinical Manager, the Clinical Guide Population Health RN performs clinical triage, high-risk outreach, condition support, care planning, clinical education, and care coordination functions in supporting Rightway members with navigating, accessing, and best supporting their care needs. The Clinical Guide Population Health RN also serves as a trusted advisor for providing clinical guidance and directing to the most appropriate high-quality care providers with the objective of improving clinical outcomes while also reducing healthcare costs e.g. minimizing ED or other unnecessary care visits while increasing utilization of more appropriate care settings, such as primary care doctors.

Clinical triage to assess the severity of the member’s health concerns using evidence-based protocols and algorithms in directing care to the right healthcare resource in a timely manner without compromising quality or safety Leveraging data-driven analytics in conducting proactive outreach to engage members of clinical interest, e.g. e high-risk, high-spend, rising risk, and evidence of care gaps with the objective of engaging and assisting members in making more informed care decisions, supporting across their continuum of care and well-being journey with lifestyle and behavior changes. Engage members in clinical conversations to best understand their care needs, assess risks, preferences, and care barriers, and then guide and recommend appropriate next steps to improve health outcomes Identify and address barriers preventing members from accessing preventative care or establishing ongoing relationships with primary care providers Assist in scheduling appointments, referrals, and follow-up care to close gaps in preventative care and chronic disease support Clinical navigation support includes but is not limited to personalized condition education, care options, and planning, care compliance, medication adherence, shared decision support, and care coordination Leverages appropriate input and direction from the Rightway clinical lead to determine the best clinical options for more complex member healthcare needs. Accurately documents symptoms/complaints, nursing assessment, the guidance provided, and member/caller response. Acts in the best interest of the member by being a health advocate and supporter in the member’s healthcare journey. Coordinates the completion of screening services for high-risk members by providing care support, adherence follow-up, and care coordination support. Member’s trusted healthcare advisor, member experience, and retention focus e.g. longitudinal care education, guidance, and support Develops effective collaboration and working relationships across the Navigation team and organization. Maintains a member-centric, customer-driven professional attitude. Stay within the RN scope of practice by strictly following our care navigation protocols unless directed to do otherwise by a provider on the clinical team and documenting appropriately when a change occurs.