Patient Navigator (Non RN)

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