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Dementia Care Navigator

4 months ago

Richmond, United States Lange Recruiting Full time
Job DescriptionJob Description

Launched in 2022, At Home Harmony (AHH) is revolutionizing healthcare delivery to seniors. As a dynamic home-based medical and pharmacy practice, were passionate about transforming healthcare for seniors and their families. Our team of dedicated clinical support staff is growing, and were seeking experienced, high-performing and forward-thinking RN, LCSW or CHW experienced in dementia focused care. We are forming a dedicated team of a dementia-focused NP or PA-C paired with a dementia care navigator. This role will predominantly be remote with phone/telehealth capability with limited home-based care/visits.

We are looking for a dementia care navigator who is interested in helping us build a geriatric dementia-based program which involves adaptability, flexibility, team-based work interest and proactive collaborative work ethic. This role has potential to grow into a lead position. Additionally, this role will work closely with other departments in our practice to administer other Medicare funded programs that align with outstanding dementia care and chronic care management. You will collaborate with our interdisciplinary team of pharmacists, nurses, MAs, phlebotomists, clinical liaisons, utilizing the latest tools and technology to enhance patient outcomes and streamline provider workflows. This is a unique opportunity for someone with big picture thinking to help develop this new program with AHH.

At Home Harmony's Dementia Care Navigator is responsible for the development and coordination of Medicare's GUIDE model within the practice. The Dementia Care Navigator's goal is to improve the quality of life of people living with dementia and their caregivers by providing education and support. At Home Harmony will provide a comprehensive training program for the Dementia Care Navigator to include both didactic instruction and experiential training. This position will report to the nurse manager.

Duties and Responsibilities of the Dementia Care Navigator:

  • Work closely with GUIDE APP and other care team members
  • Proactively reach out to patients and caregivers and provide education and training, according to internal protocols
  • Provide patients and caregivers with targeted resources and support based on care plan goals.
  • Conduct screenings to determine caregiver needs and eligibility for services.
  • Provide aid to family caregivers in obtaining appropriate services or benefits, including assistance with forms, advocacy, supportive counseling, service referral, and follow up.
  • Collaborate with local community agencies, providers, and other stakeholders to facilitate access to essential services for patients and caregivers.
  • Engage and escalate care needs to appropriate AHH clinical team
  • members.
  • Administer and follow up on surveys and screening tools.
  • Participate in team meetings and training as required or appropriate.
  • Successfully complete and pass the internal AHH dementia and elder care training programs.
  • Participate in quality improvement initiatives.
  • Create and shape a culture of quality and safety within AHH by following internal and external protocols for reporting safety events.
  • Adaptable to change as the program is built.


Job Requirement:

  • 3+ years experience working with dementia patients or with geriatric populations.
  • Dementia care certification (preferred)
  • Valid RN or LCSW license (preferred)
  • Program development (preferred)
  • Strong organization skills
  • Flexibility and ability to thrive in an environment where rapid change occurs regularly.
  • Strong work ethic and communication skills
  • Proficiency with electronic medical records (EMRs) and Microsoft Word