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Patient Care Navigator RN
2 months ago
Position Title & Specialty Area:
Patient Care Navigator Inpatient
Department:
Comprehensive Care Management
Location:
Plano
Shift:
Dallas
Job Type:
On Site
Why Choose Children's Health?
At Children's Health, our commitment is to enhance the lives of children, recognizing that their health is pivotal to this mission.
Through innovative treatments and our partnership with UT Southwestern, we aim to provide an exceptional experience for patients and their families, ensuring that every interaction, whether significant or minor, contributes positively to their overall health.
Together, we can significantly influence the lives of children and foster a healthier future for everyone.
Overview:
Leveraging advanced nursing expertise, the Patient Care Navigator is accountable for orchestrating care throughout the healthcare continuum for a designated patient demographic.
In collaboration with the patient, family, and other caregivers, the Patient Care Navigator will engage with a multidisciplinary team, including Providers, Nurses, Social Workers, financial advisors, and other support staff to actively facilitate the processes associated with guiding the patient through the continuum of care.
This role is vital in supporting continuity of care by advocating for the patient and family’s needs, working with designated care team members to enhance access to care, facilitate communication, and ensure effective resource coordination during transitions to guarantee continuity, quality, and closure of care gaps.
The Navigator identifies and implements initiatives aimed at process improvement.Key Responsibilities:
- Accountable for prescribing, delegating, and coordinating patient care. Utilizes clinical judgment based on nursing expertise gained through formal and experiential learning, along with evidence-based guidelines, to globally assess the patient's condition and develop a suitable care plan aimed at achieving optimal outcomes.
- Ensures that patient care adheres to standards of safety, effectiveness, patient rights, and guest relations.
- Oversees care provided by the patient care team; coordinates the care plan.
- Educates and facilitates learning for patients, families, and the patient care team, demonstrating sensitivity to diversity.
- Collaborates with physicians, families, and other healthcare professionals to assist in developing and implementing an appropriate care plan that encourages each individual’s contributions towards achieving the best patient outcomes.
- Advocates for the patient, addressing the concerns of the patient/family and identifying and assisting in resolving ethical and clinical issues.
- Delivers care with a team-oriented approach, emphasizing excellent customer relations, sound clinical judgment, and appropriate decision-making based on evidence-based practices.
- Continuously evaluates the patient’s condition through ongoing inquiry and assessment, implementing treatment modifications as necessary in collaboration with the healthcare team, including the patient and family.
- Maintains a comprehensive knowledge base and tools that enable the nurse to manage available resources for the patient/family across healthcare and non-healthcare systems.
- Care Coordination /
Disease Management:
- Conducts and analyzes comprehensive assessments during patient intake.
- Collaborates with the healthcare team on the care plan, referrals, and ongoing patient needs.
- Ensures that consults, testing, and procedures are appropriately sequenced based on the patient's clinical condition to support timely and efficient care delivery. Intervenes, resolves, or escalates issues where barriers to service exist.
- Utilizes disease-specific clinical pathways to ensure effective clinical/disease management.
- Assesses the educational needs of patients, families, and caregivers, considering barriers to care (e.g., literacy, language, cultural influences, comorbidities).
- Ensures that education regarding the clinical/disease process is provided by the healthcare team.
- Coaches patients/families towards lifestyle changes and successful self-management of chronic diseases.
- Demonstrates customer-focused interpersonal skills, employing problem-solving processes and critical thinking.
- Facilitates communication and coordination of the care plan with Providers and the healthcare team.
- Involved in developing strategies and plans to maximize the appropriate use of services in assigned areas.
- Resource Management:
- After considering relevant, evidence-based clinical information, supports and advises patients, families, and the organization on the most cost-effective care options.
- Navigates payor benefits and assists patients and families in understanding insurance plan benefits and financial implications during transition management and discharge planning.
- Understands the impact on the organization and utilizes knowledge of Diagnosis Related Groupings and estimated length of stay as guides when developing discharge plans.
- Recognizes the negative impact of readmissions on patients and the healthcare system, engaging in root cause analysis and implementing strategies to prevent readmission.
- Discharge Planning /
Transition Management:
- Identifies and addresses actual and potential barriers in service or treatment, collaborating with appropriate resources across the continuum of care.
- Evaluates the patient’s response to pharmacological and therapeutic treatment regimens with the team.
- Works with multidisciplinary staff to ensure the patient/family receives appropriate information and education prior to transitioning to the next level of care.
- Identifies and resolves problems related to discharge needs; implements a care plan and coordinates a safe and timely discharge.
- Ensures consensus on the plan from the patient/family, healthcare team, and payor.
- Advocates, mediates, and negotiates to formulate a cohesive plan for maintaining or enhancing the patient’s health status and safely transitioning to the next level of care.
- Communication:
- Communicates and resolves conflicts with Providers, healthcare team members, community agencies, clients, and families with diverse opinions, values, and cultural ideals.
- Builds therapeutic and trusting relationships with patients, families, and caregivers through effective communication and listening skills.
- Continuously communicates with patients and families, Providers, multidisciplinary team members, and payors to facilitate coordination of clinical activities and enhance seamless transitions across the continuum of care.
- Managing Key Performance Indicators (as defined by the hiring manager):
- Works to enhance quality by reducing treatment delays, utilizing clinical pathways, and monitoring quality indicators.
- Provides ongoing consultation and training to medical staff and other healthcare professionals on discharge and home care issues; participates in process improvement activities; identifies barriers in service delivery systems and develops improvement processes.
- Increases quality, efficiency, and patient satisfaction while managing care costs for the targeted population.
- Collects, completes, and submits statistical data in a timely manner.
- Professional Development:
- Remains current in EMTALA and regulatory requirements.
- Stays informed about payor guidelines and standards.
- Keeps abreast of community resources available to facilitate safe patient transitions of care.
- Remains updated on clinical advancements related to the primary patient population.
- Proactively seeks to understand roles outside of immediate responsibilities within the department.
- Engages in community involvement and advocacy: participates in health fairs, relevant professional organizations, and educational speaking engagements.
WORK EXPERIENCE
- Minimum of 4 years in Pediatric nursing, Case Management, Care Management, Care Coordination, Utilization Review, or Community-based nursing required.
EDUCATION
- BSN required.
LICENSES AND CERTIFICATIONS
- Registered Nurse in the State of Texas required upon hire.
- Accredited Case Manager (ACM) or Certified Case Manager (CCM) or Care Coordination and Transition Management (CCTM) preferred upon hire.
- Effective 7/1/2023, Basic Life Support for Healthcare Providers as required by CP 1.20 Life Support Course Requirements.
We prioritize our people. We welcome, value, and respect the beliefs, identities, and experiences of our patients and colleagues.
We are dedicated to delivering culturally effective care, fostering meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.
Holistic Benefits - How We'll Care for You:- Employee portion of medical plan premiums are covered after 3 years.
- 4%-10% employee savings plan match based on tenure.
- Paid Parental Leave (up to 12 weeks).
- Caregiver Leave.
- Adoption and surrogacy reimbursement.
As an equal opportunity employer, Children's Health does not discriminate against employees or applicants based on race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other legally protected status or class.
This applies to all aspects of the employer-employee relationship, including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.
