RN Disharge Navigator

Employment Type

Full time

Shift

Description:

POSITION PURPOSE

The purpose of the RN-Discharge Navigator is to serve as a consistent care coordinator for MercyOne clinic patients being discharged from the hospital and emergency room. The coordinator will collaborate with the care coordination and clinical teams to assure the patient needs are met and all follow-up is transitioned to the ambulatory care team. The Navigator will be the liaison with the patient, providers, care team, family and other involved parties to identify and eliminate barriers to care to achieve an optimal clinical outcome. The coordinator will also serve as a resource for patients needing to establish care with MercyOne Clinics across the region.

Essential Functions

• Knows, understands, incorporates, and demonstrates the MercyOne (Trinity Health) Mission, Vision, Core Values, Actions and Promise in behaviors, practices, and decisions.
• Identifies problem areas in need of focused attention and implements actions to drive improved outcomes.
• Coordinates patient care in collaboration with the acute and ambulatory care team across the continuum of care.
• Manages the timely transition and follow-up post hospital discharges or emergency room visits ensuring appointments and follow up visits are scheduled.
• Ensure care documents and discharge notes are accessible to the ambulatory care team to ensure seamless transition and communication.
• Coordinates post hospitalization advanced imaging as needed, supporting communication with ambulatory care teams and ordering or tasking of discharge orders.
• Coordinates with clinic manager for access challenges and concerns to ensure timely follow-up. Escalates access concerns to Medical Group leadership.
• Identifies and refers patients appropriate for resource referrals including care management, high risk health coaching and community health workers.
• Document all patient coordination activities, education, and other interactions in designated inpatient and outpatient electronic health record systems to assure a timely, complete patient record and effective communication with other members of the care delivery team.
• Assist with tracking, documentation and outcome reporting for navigation services.
• Identify opportunities to develop improved processes and prevent hospitalizations, readmission and unnecessary emergency room visits.
• Supports patients in establishing care with MercyOne clinics and maintaining awareness of providers with access and limitations.
• Perform other duties consistent with the purpose of the job as directed.
  
  

Education

MINIMUM QUALIFICATIONS

• Bachelor’s degree in nursing, health administration or related field required.
• Iowa licensure as a Registered Nurse.
  
  

Experience: Requires a minimum of three (3) years in clinical setting.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

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