Job Description
Job Summary
The Patient Navigator (non-RN) is responsible for improving patient's level of wellness, reducing unnecessary readmissions and ensuring appropriate utilization of in-network healthcare resources. The Patient Navigator collaborates with facility leadership and Care Managers to review trends in resource utilization.
Essential Functions
- Establishes and maintains a post-acute preferred provider network in conjunction with facility/ACO regulations and bylaws.
- Evaluates the Post-Acute Referral process and identify opportunities for improvement in a knowledgeable, skillful and consistent manner.
- Effectively utilizes care coordination and tracking software to understand and influence readmission factors and utilization patterns.
- Provides education to physicians and other referral sources regarding post-acute services and in network utilization.
- Reviews patient care concerns and identify resolution of issues to meet patient care needs.
- Reviews readmissions rates and readmission retention rates of post-acute providers and initiate discussions with those providers to seek improvements in performance.
- Review PAC utilization to include ALOS, RUG levels, ED visits, and multiple PAC transfers.
- Provides monthly utilization reports to PAC providers and ACO leadership
- Documents interactions with patient, family, hospital staff, and providers in accordance with the facility-specific documentation policies.
- Regularly communicates progress in the development of the post-acute referral network.
- Establishes relationships with community resources to mitigate patients' socioeconomic issues that lead to an increase in readmission and healthcare utilization.
- Supports the goal of continuous Quality Improvement by making pertinent suggestions to improve efficiency and/or to contain costs, improve In-network utilization/Readmission and to improve customer service and customer satisfaction.
- Monitors the Accountable Care Continuum for patients discharged from the facility, which includes, but it not limiited to, discussing utilization patterns of participating and non-participating resources (including physicians, hospitals and post-acute care providers).
- Performs other duties as assigned.
- Complies with all policies and standards.
Qualifications
- Associate Degree In Health Related Field preferred
- 2-4 years strong clinical/healthcare experience required
- 2-4 years Supervisory and project leadership experience preferred
- 2-4 years Prior experience as a Care Navigator for high-risk patient populations preferred
Knowledge, Skills and Abilities
- Current working knowledge of discharge planning, utilization management, care management and disease management.
- Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre-and post-acute care.
- Knowledge of Medicare and ACO practice management preferred.
- Demonstrated ability to communicate effectively in person and via telephone with patients, families/caregivers, physicians, physician office staff, and Post-Acute providers using appropriate dialogue and customer service competencies.
- Can aggregate and evaluate patient level data focusing on medical, psychosocial, and the education needs utilizing established post- acute criteria.
- Ability to perform multiple activities, meet deadlines, solve problems, utilize resources, make independent decisions, and work well in a team-based environment.
- Hands-on individual with great attention to detail, high personal accountability, and strong drive to develop him/herself while learning business model.
- Strong organizational skills.
- Excellent written and verbal communication skills.
- Proficient in Microsoft Office products such as Word Excel, PowerPoint, Outlook.
Licenses and Certifications
- A current, unencumbered Nursing or Social Work, license preferred
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