Clinical Care Navigator

Job Description

Job Description

JOB SUMMARY

Responsible for the clinical management and scheduling of services for an assigned group of patients. Responsible for providing / performing patient related nursing services.

REQUIREMENTS

• Education :
• Graduate of an accredited nursing program.
• Bachelor of Science in Nursing preferred.
• A registered nurse licensed, currently registered in state working in and in good standing with the Board of Nursing.
• Experience :
• A minimum 5 years of experience in home care or home infusion therapy with management experience.
• Knowledge of ACHC and URAC standards and accreditation process.
• Knowledge of regulatory requirements for home care New York and New Jersey.
• Good communication skills, detail oriented and organized.
• Fulltime or Part-Time Employment :
• Fulltime-40hrs per week. Work week is Monday thru Friday
• Part-Time-29hrs or less Work week is Monday thru Friday
• Schedule determined by supervisor.

RESPONSIBILITIES

Clinical Care Navigation

• Coordinate all patient care services for an assigned group of patients with other members of the health care team.
• Obtain referral information for new patient referrals and enter the referral into Specialty Pharmacy Business Operating System systems.

Review referrals for completeness.

• Process referrals to case management for insurance verification.
• Coordinate patient discharge / start of care with referral source / discharge planner.
• Obtain initial orders / prescription for care. Complete the plan of treatment at the start of care and update as care needs change or every six months.
• Complete initial telephonic assessment with the patient to determine medical needs, functional limitations and willingness to participate in care.
• Develop the patient’s initial supply list based on the patient’s individualized care needs.
• Maintain accurate and complete information in the Specialty Pharmacy Business Operating System systems for assigned group of patients including, but not limited to : demographic information, medical information (height and weight, diabetes status, past medical history), nursing care provider, contact persons.
• Provide clinical support to the patient, field staff and pharmacy staff.
• Based on the initial telephonic assessment and in conjunction with pharmacy, determine the appropriate administration method for prescribed therapy.
• Participate in daily patient care rounds to discuss pending referrals, current patients and clinical issues.
• Review nursing documentation to assure accurate and thorough information.
• Track nursing visits by patient and obtain authorization for additional visits through case management.
• Participate in the company’s after hours on call system as needed.
• Participate in the company’s Quality Assurance Program.
• Audit patient medical records for assigned group of patients to assure complete and accurate documentation.
• Participate in daily patient care rounds to coordinate patient services between nursing, pharmacy and reimbursement.
• Performs skilled nursing visits to all ages of patients as needed.

Operational (Where required)

• Acts as the Alternate Nursing Supervisor where required. Responsible for overseeing the operations and management of the local Home Health Agency in the absence of the Regional Nurse Manager / Administrator.
• Is available to the agency, either in person or by telecommunication in the absence of the Regional Nurse Manager / Administrator.
• Any other responsibility as designated by the employee’s supervisor.
11 days ago