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Joy Scott | February 07, 2019

Have you gotten a call from one of our clinical navigators? If not, you may get one soon. Read on to learn more about this innovative new role at AllWays Health Partners.

What are clinical navigators?
The AllWays Health Partners clinical navigators are nurses who provide personalized transition and advocacy services to members, including fast referral and authorization support. All our members can take advantage of our clinical navigators. However, employer groups with 100 or more enrolled subscribers have an assigned clinical navigator who works with their sales account team.

Simplifying the health-care experience
Modern health care has gone way beyond “take two of these and call me in the morning.” More advanced treatment options add more complexity to the system. And that’s before we even consider costs.

A recent New York Times article concludes what we all know: health care is simply too overwhelming for the average person – even a very savvy, motivated person – to manage on their own. Given how high the stakes are when patients are making care decisions, it seems unreasonable to expect them to go it alone.

Help with care – and cost – decisions
AllWays Health Partners introduced the clinical navigators so that members would have someone – an actual person – to go to with questions about the “business side” of health care. Unlike care managers, clinical navigators help members manage the health care system, not their health. They can help patients fast-track prior authorizations, understand their options after a denial, or access the benefits available to them during life events like a new diagnosis or a pregnancy.

Our clinical navigators work closely with care managers to coordinate care on behalf of our members. And, in some cases, they work directly with providers, too.

Navigators reaching out
Navigators will often contact a provider practice to help facilitate a prior authorization. They may also reach out for help finding alternative options if a member has been denied services. Part of their job is to make these processes easier for our providers as well as our members.

Topics: Customer service, Health & wellness


 

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