Clinical Navigator - Heart Failure & Advanced Heart Failure - Per Diem

Summary:

Responsible for partnering with the physician and multidisciplinary team in coordinating patient care with the underlying objective of enhancing quality and cost effective care.

Acts as a resource and patient advocate to facilitate a safe transition across the continuum.

This is a primarily telephonic role that will service two distinct groups – Virtua employees and patients that utilize the VPP/Aetna insurance product that will be marketed through Virtua Physician Partners.

Position Responsibilities:

Care Coordination

• Completes appropriate assessments for assigned practices using standardized tool and plans effectively to meet patient educational and psychosocial needs.

• Promotes efficient utilization of resources.

•The outreach will be based on utilization and/or proactive outreach (i.e., patient cancels appointment, hasn’t been seen, and missed routine screenings) with the goal to direct them to appropriate services.

• Engages the physician and builds seamless continuity of care.

• Helps identify factors impeding patient progression, resolves, escalates and documents as appropriate.

• Meets with identified practices to review cohort metrics and share knowledge of best practice and available resources to achieve quality and cost effective care (Virtua Physician Partners positions only).

• Coordinate education and resources and care for VMG primary and specialty offices.

Documentation

• Appropriate and complete documentation of individual plan of care in EMR.

Metrics

• Accountable to job specific goals, objectives and dashboards which contribute to the success of the organization.

• Participates in organizational improvement activities including patient satisfaction, Six Sigma committee, department and/or divisional teams and community activities.

Compliance

• Understands and applies applicable federal and state requirement.

• Identify and reports compliance issues as appropriate.

Position Qualifications Required / Experience Required:

Preferred: 3 years clinical nursing (RN) experience and 1 year UR/CM/QM experience or 3 years experience as Clinical Social Worker.

Basic understanding of Medicare, Medicaid and managed care.

Discharge planning or home health background.

Excellent verbal and written communication skills, problem solving, critical thinking and conflict resolution.

Required Education:

Graduate of an accredited School of Nursing or Graduate of an approved School of Social Work with a Master’s Degree.

BSN preferred.

Training/Certifications/Licensure:

Licensure and/or certification from the State of New Jersey as a LSW or LCSW or Registered Nurse.