Nurse Navigator Medical Cost Management

Apply for the Nurse Navigator Medical Cost Management role at UNITE HERE HEALTH
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This range is provided by UNITE HERE HEALTH. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$85,300.00/yr - $/yr

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our vision is exciting and challenging.

The Nurse Navigator is a licensed clinical professional who supports members in navigating the healthcare system, coordinating care, and improving health outcomes. This role focuses on reducing unnecessary emergency room utilization, enhancing chronic disease management (especially for diabetes and ESRD), and promoting cost‑effective care through education and network optimization. The Nurse Navigator works collaboratively with members, providers, and internal teams to address barriers to care and support population health initiatives.

• Serve as a clinical resource and point of contact for high‑risk and high‑cost members, guiding them through care coordination and benefit utilization.
• Educate members on chronic disease management, preventive care, and appropriate use of healthcare services, with a focus on diabetes and ESRD.
• Identify and address social determinants of health (SDOH) that impact access to care and adherence to treatment plans.
• Support members in locating in‑network providers and facilities to reduce out‑of‑network and emergency room usage.
• Coordinate referrals, post‑discharge planning, and medication adherence strategies.
• Collaborate with network case managers, social workers, and providers to ensure timely and appropriate care delivery.
• Conduct outreach to at‑risk populations to promote engagement in wellness programs and adherence to care plans.
• Partner with community‑based organizations to connect members with additional support services.
• Document all member interactions and interventions in compliance with HIPAA and payer‑specific guidelines.
• Monitor and report trends related to gaps in care, member concerns, and program effectiveness.

• 3+ years of experience in care coordination, case management, or patient navigation.
• Spanish Bi‑lingual skills (preferred).
• Strong understanding of health insurance plans, provider networks, and value‑based care models.
• Clinical experience in chronic disease management, especially diabetes and ESRD.
• Excellent communication, critical thinking, and interpersonal skills.
• Ability to work with diverse populations and address health equity challenges.
• Proficiency in electronic health records (EHR) and payer systems.
• Experience in managed care or payer settings is a plus.
• Knowledge of community health resources and support services.
• Registered Nurse (RN) license required.
• BSN or higher (preferred).
• Certified Diabetes Educator (CDE) or equivalent experience in diabetes education.
• Certification in Case Management (CCM), Public Health (CPH), or similar credential.

$85,300 to $106,700.

Monday thru Friday, 7.5 hours per day (37.5 hours per week) as a flexible hybrid employee.

Medical, Dental, Vision, Paid Time‑Off (PTO), Paid Holidays, 401(k), Short‑ & Long‑term Disability, Pension, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

Mid‑Senior level

Full‑time

Health Care Provider

Hospitals and Health Care