Care Navigator - RN
at Volunteers of America

Date Posted: 11/26/2019

Job Description

At Tiffin Rehabilitation Center, we believe creating a positive community starts by treating our staff with the same care and respect they give our patients - a practice that earned us a Bronze employer of Choice designation from Leading Age Ohio.

We are looking for a Care Navigator (RN) to join our team at Tiffin Rehabiliation Center!  This position must be able to travel to different locations in the Tiffin, Fremont, Toledo, and surrounding areas.  


OBJECTIVE: The primary function of the Care Navigator is to assist patient /families and hospital staff (social workers, nurse case managers, physicians, nurse practitioners) with a smooth transition from acute to post-acute care and services offered at Autumnwood Care Center, Tiffin Rehabilitation Center, and Bethesda Care Center (VOANS locations). Acute care referral outreach, beyond the local Tiffin and Fremont markets, is expected with a focus on Toledo hospital systems and surrounding areas.

ESSENTIAL FUNCTIONS:

1. Work closely with each VOANS location’s admission, financial, and clinical teams and attend daily video conference meetings for communication of referrals, admissions and transfers.
2. Participate in on-going educational program in the profession to maintain professional licensure and remain current on trends in the healthcare field.
3. Participate with the Directors of Nursing and Executive Directors in joint meeting and/or periodic reviews
4. Ensure compliance with organization policies and governmental regulations.
5. Oversee project assignments that may be specific or general in scope to benefit the structure and goals of VOANS locations.
6. Attend and participate in VOANS locations regularly scheduled management meetings.
7. Submit regular and marketing reports in the prescribed format concerning all matters of major importance, such as encounter results, next steps and key messages, as they relate to scope of work.
8. Assist and make recommendations for the development and distribution of marketing collateral, to include community outreach and public relations opportunities.
9. Be familiar with the Fremont, Tiffin, Toledo, and other surrounding markets. The Care Navigator will have a good working knowledge of the healthcare network to include hospital, physicians, hospice, home health agencies, and others, and develop database.
10. Other tasks as assigned.

The Care Navigator’s responsibilities can be divided into 2 broad categories: Case Management and Customer Service.

1. Case Management
a. Streamline admission process from referring hospital systems and other sources to VOANS facilities.
b. Works cooperatively with the Business Office Managers at VOANS facilities to ensure verified payment source.
c. Works cooperatively with VOANS admission staff, as an extension of this office.
d. Increases VOANS conversion ratios from referral to admission.
e. Appropriately assists with decreasing referring hospital inpatient length of stays. This is accomplished by working with the hospital discharge planning team on forecasting, planning and acting on expedited discharge processes. Demonstrates cost savings to referring hospital systems as evidenced by decreased inpatient length of stays. Identifies partnering opportunities to meet mutual goals. May serve on joint committee and task forces.
f. Works with referring hospitals on removing admission barriers, while ensuring that VOANS facilities are able to meet the patient’s clinical needs.
g. The Care Navigator will be available to assess patients at a clinic, urgent care center, observation/swing beds, emergency room, LTACH, physician office or home setting for placement options within VOANS locations.
h. Comfortable with discussing advance directive and end of life care with patients and families.
i. May conduct post-discharge home visits from VOANS locations as a matter of best practice and/or follow-up transitional success.
j. May accompany patients at specialist appointments as a means of continuity, clear communication and a marketing opportunity, to further build relationships with key referral sources.
k. Attend network meetings on behalf of VOANS centers.

2. Customer Service
a. Be visible and accessible within referring hospital systems, and other referring locations.
b. Be available to educate patients and their families about VOANS locations, and discuss realistic expectations to help alleviate anxiety and correct misperceptions about a short-term stay in a healthcare center or the benefits of living in a VOANS location.
c. VOANS nursing staff will communicate directly with the Care Navigator on patient assessments and care issues, with the intent of decreasing the workload for the referring hospital nurses.
d. The Care Navigator has the knowledge, time, and ability to be an educational resource for discharge planning teams, rounding physicians, hospitalist, nurse practitioners and others.
e. The Care Navigator will attempt to visit all patients referred to initiate a bedside clinical assessment, schedule a site tour, and complete pre-admission paperwork prior to the patient’s discharge from the hospital for a warm hand-off to a VOANS location.
f. The Care Navigator will visit all VOANS patients re-admitted back to Promedica Hospital and Mercy Hospital within 48 hours, depending on proximity.
g. Connect with other providers while accompanying patient to advocate and communicate outcomes.

 

Job Requirements

QUALIFICATIONS: 

1. Bachelor’s degree in Nursing as a Registered Nurse.
2. Strong clinical assessment skills.
3. Familiarity with clinical capabilities at VOANS locations.
4. Strong communication (written, verbal, electronic) and customer service skills.
5. Ability to problem solve with referral sources.
6. Ability to work autonomously and remote.
7. Strong knowledge of long-term and transitional care settings.
8. Ability to utilize computers and other electronic devices for tasks such as timekeeping, in-servicing, video conferencing, accessing various health system EMR portals to obtain and review referrals, and documentation.
9. Knowledge of Medical Assistance, Medicare, managed care, Medicare replacement program, and other funding sources and the healthcare continuum of acture, post-acute, long term and transitional care.
10. Ability to prioritize, set goals and achieve results.
11. Ability to work flexible hours is required. Ability to travel required, routinely 75% - 80%.
12. Must have valid driver’s license, proof of insurance and reliable transportation.
13. Ability to pass all requirements for hospital vendor access.

EOE M/F/Vets/Disabled

Job Snapshot

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