Patient Navigator

This position is integral to the operation of clinical services delivered under the CMS GUIDE model. The care navigator will serve as a primary point of contact for person with dementia and their caregivers and coordinate a range of services, described in detail below. They will also have responsibility for aggregating data collected and coordinating communication with CMS.

Principal Duties and Responsibilities:

Responsibilities related to implementing the GUIDE Model:

•Coordinating intakes and approval for beneficiaries to participate in GUIDE

•Conduct Home Visit Assessments: safety of home, ADL assessment, environmental factor

•Participate in developing person-centered care plan for GUIDE beneficiary and caregiver, where applicable

•Serving as primary point of contact for the GUIDE Beneficiary and their Caregiver.

•Managing the person-centered care plan as needed, identifying unmet needs and coordinating clinical and community-based services and supports, monitor medication management and adherence, and provide caregiver education and support.

•Serving as liaison with the Care Team's clinical team members for any medical or other issues that present with complexity, and coordinating care with PCPs and other providers.

•Additional care coordination responsibilities as required by the GUIDE Care Team.

•Providing additional information and supports to help the GUIDE Beneficiary as indicated, including maintaining a directory of resources in the service region for McLean.

•Coordinating caregiver support as required by the GUIDE Model agreement, including providing resources and one-on-one calls to facilitate care as needed. .

•Coordinating peer-to-peer support services as indicated, in consultation with the care team.

Responsibilities related to Management of the Project:

•Coordinate preparation and communication of progress reporting and deliverables to sponsor

•Develop, communicate, and execute project timelines, milestones, KPIs.

•Support key external-facing activities and initiative

•Develop and operationalize a QA/QC plan for cleaning and maintenance of data

•Oversee database management as required

•Perform data quality audits as required

•Present and participate in regular meetings with members of the operational and clinical team

•Oversee day-to-day operations of project

•Contribute to development and revision of project policies, procedures, and toolkit

•Prepare manuscripts, abstracts, posters, and presentation

•Project administrative activities as required

•Supervise research assistants or administrative staff who will work on GUIDE models roles.

•Maintain regulatory oversight of all project-related and project adjacent initiatives (e.g. research projects embedded within GUIDE), including supporting IRB applications and preparing annual reports.

•Use/s the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration

•Other duties as assigned

Qualifications

Qualifications:

•Bachelors degree is preferred

•A combination of education and experience may be substituted for requirement

•Experiece working with older adults and/or persons with dementia.

Skills/Abilities/Competencies:

•Completing training required by CMS, to serve in the care navigator role.

•Possess strong interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization

•Ability to successfully negotiate and collaborate with others of different skill sets, backgrounds an levels within and external to the organization

•Strong problem solving and negotiation skill

•Ability to effectively conduct meetings, both formal and informal

•Requires minimal direction from leadership and possesses the ability to learn quickly

EEO Statement

McLean is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All

qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin,

ex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected

under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in

the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of

employment.