Job Description

Job Description

Description
GENERAL SUMMARY:

The Specialty Program Care Navigator (RN) is an integral member of the specialty programs developed within the Institute structure. The overall goal of the Care Navigator is to facilitate an evidence-based, multidisciplinary, multi-specialty approach to care throughout the care continuum. The Care Navigator oversees the development and redesign, as needed, of patient education, of evidence-based standards of clinical care and the post discharge rehabilitation care. The Care Navigator is the patient-facing team member of the program who is responsible for coordinating the patient through the entire continuum of care across the division, and beyond for the quaternary destination programs. This includes all related appointments, obtaining all necessary authorizations, remaining in constant contact with the clinical team, discharge phone calls, and post discharge follow-up. Responsible for answering patients questions pertaining to specialty program navigations, scheduling, and insurance information. Serves as first responder to patient issues and works to find solutions to any barriers that arise. The navigator is in contact with physicians, hospital departments, testing locations, and procedural departments to help coordinate care. The Navigator will be available to assist with patients who interact with both private and employed physician entities. Coordinates orders for procedures and follow-up imaging, obtaining and uploading into system as necessary. Oversees scanning all procedure documents and notes into Cerner, Aria, Athena, and other related EMRs. Assists in weekly multidisciplinary meeting preparation and follow-up. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. The CC gathers, records, and evaluates program data and uses this data in establishing program goals with the oversight of the Medical Director and the Service Line Director. This position is accountable for the ongoing monitoring of program quality and assists with program marketing needs. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

Demonstrates, through behavior, AdventHealths core values of Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork.

Facilitates an evidence-based, multidisciplinary, multi-specialty approach throughout the care continuum for the destination, quaternary program. Assists with the monthly service line meetings presenting clinical data and recommending process improvements.

Remains current in evidence-based practice and new emerging trends. Participates in the development of practice standards including pre-op, post-op and discharge instructions. Facilitates the development of patient education classes specific to surgeries.

Develops, tracks, and benchmarks (in collaboration with the physician/administrative team) program outcomes related to clinical/operational goals Data analysis to align with FH overall goal of tracking to support efforts related to pay for performance reimbursement.

Promotes the Clinical Coordination Program awareness within the physician community and the community at-large. Participates in marketing through physician visits, dinners, educational seminars, and community lectures. Develops appropriate relationships to maximize the Clinical Coordinated Program effectiveness and facilitates program problem resolution across departmental, campus, and physician/ provider lines.

Navigates the patient within the specific area of concentration i.e., Bariatrics, esophageal, spine, womens medicine and oncology from pre-op education through the hospital stay and post rehabilitation stage, ensuring the patients have appropriate, timely, medical, supportive services through a multidisciplinary approach to patient care. Addresses appointment coordination, record requests, insurance concerns, education, and communicating information between the physician office and the patient, etc.

Provides onsite mentoring of the staff within the specific area of concentration i.e., Bariatrics, esophageal, spine, womens medicine and oncology. Implements strategies for critical thinking. Assists with Nursing education conferences and the yearly competencies required by regulatory agencies. Reports clinical issues with Director and nursing administration as needed.

Oversees the development and updating of various forms and materials including nursing competencies and check off forms, educational packets and tracking records. Participates in data collection for submission to clinical excellence programs and as required for insurance excellence of care programs.

Accountable to performance metrics as defined by the Institute and the direct leader

Acts as single point of patient contact for concierge style treatment. Will be the system navigator and point of contact for patients and families.

Will meet with patients and family face-to-face as is defined by the program requirements

Addresses and responds to patient non-clinical questions. Responds to email correspondence from hospital staff, administrators and physician offices, securing necessary information and resolving issues within a timely manner.

Understand the complexities of different office, procedural, OR environments gained through ongoing shadowing experience and site visits

Receive referral and records, and maintains record of referrals from various specialties

Responsible for greeting, instructing, directing and scheduling patients

Responsible for discharge coordination, navigation, and lifetime follow-up as is required for the specific disease status

Contacts patients directly for first consultation to discuss the reason for referral and describe procedures to the patient.

Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.

Verifies benefits and obtains insurance authorization for all patients

Ensure complete and accurate registration, including patient demographic and current insurance information.

Notifies physician and administrative leadership of any benefit problems. Answers insurance benefit/authorization questions for patients and families and process all necessary paperwork.

Contacts physician to arrange peer-to-peer discussions as necessary.

Collects co-pays as necessary.

Schedule procedure and send order to facility for scheduling, and sends out procedure info to the patient

Identify and assemble any tasks that physician or care team needs to address on a regular basis, including but not limited to specialty reads, interpretations, consultations, etc.

Coordinates nutrition and transportation orders for the day of the procedure.

Remind patients of scheduled appointments via mail, phone, text, or application as is acceptable per company policy

Updates computer system of all necessary information related to insurance benefits and authorizations. Documents the authorization and verification of benefits in the patients chart.

Communicates necessary patient information to the nursing staff.

Scan reports into Athena/Cerner/other EMRs

Send OV notes and procedure findings to referring physician

Collaborates with Physicians, ARNPs, PAs, executive assistants, to schedule patients for procedures, consultations, and follow-up.

Provide results/findings to referring physician.

Schedules patients for follow-up diagnostic testing, treatment, and appointments as per physician orders, obtains and uploads images as necessary.

Oversees scanning of all procedure documents and notes into Cerner and Aria after procedure is completed.

Assists with weekly multidisciplinary meeting preparation and post meeting tasks.

Qualifications
KNOWLEDGE AND SKILLS REQUIRED:

Team-centered leadership and facilitation skills; ability to interact appropriately with department/teams to facilitate process development, quality improvement, and interaction with patients/families and the specialty program team

Strong organizational, communication, and customer relations skills; ability to communicate effectively with diverse populations

Knowledge of insurance verification and authorization process

Understanding of insurance requirements for scheduling medical tests

Flexibility in prioritization; ability to multitask; critical thinking/problem solving skills

Proficiency in Microsoft (Word and Excel)

Effective oral and written communication skills

Ability to speak confidently with physicians and leadership

Self-directed with the ability to be a part of a team

Knowledge of medical terminology

KNOWLEDGE AND SKILLS PREFERRED:

Knowledge of computer software, particularly Cerner, Aria, Athena, and Sunport

EDUCATION AND EXPERIENCE REQUIRED:

Graduate of a school of nursing

Three years experience as a medical/surgical nurse

EDUCATION AND EXPERIENCE PREFERRED:

Bachelors or Masters degree in Nursing

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:

Current valid State of Florida or multi state license as a Registered Nurse

Florida Drivers License

LICENSURE, CERTIFICATION, OR REGISTRATION PREFERRED:

Medical coding, billing, and insurance certificates

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.