McLaren Health Care Healthcare Navigator in Lansing, Michigan
Oversees patient care activities that affect readmission rates and continuum of care outcomes. Assists in the planning, implementation, and analysis of quality assessments activities and makes recommendations to improve processes.
The Healthcare Navigator is a clinical liaison between the healthcare team providers and the patient to ensure continuity of care for identified high risk patients transitioning from the hospital to the next level of care with the goal of reducing fragmented or unsafe care and to reduce potentially preventable readmissions.
Collaborate with Case Manager, Social Worker, Nurse, patients’ caregiver, Primary Care physician and Attending physician as indicated regarding identified high risk patients current treatments, medication, chronic condition, code status, services prior to readmission and anticipated discharge needs and strategies.
Provide support to patient and the healthcare team throughout the transition process with proactive effort in care coordination.
Lead and facilitate collaborative internal and external teams meetings as needed to promote process improvement in optimizing patient care.
Post Discharge; facilitate contact with patient, caregiver or facility within two days of hospital discharge to assess needs and transition; i.e. medication changes/prescriptions filled, DME/supplies, follow up appointment, services, changes in condition.Address issues as indicated.
Assists in establishing department policies and procedures, professional staff protocols, and other pertinent professional staff QI activities in alignment with the hospital’s strategic goals and expectations.
Acts independently; consistently exercises discretion and judgment in performing work which is predominantly intellectual and varied in nature.
Knows, understands, incorporates and demonstrates the McLaren Health Care/McLaren-Medical Group Vision, Mission and Values.
Identifies patient/family learning needs and directs teaching according to standards of care.
Participates in the development, coordination and implementation of Integrated Plans of Care (IPC).
Documents case management activities/intervention in the medical record.
Participates on various Medical Center Committees, quality activities and work groups as assigned.
Assume responsibility for continuing education/professional development related to area of practice.
Adheres to National Patient Safety goals.
Provides for the age specific needs of the population served according to department standards, as evidenced by observation, documentation, and peer feedback.
Using established criteria, reviews medical records within 24 hours following date of care to determine medical necessity and provides education and follow-up as necessary for physicians and others.Notifies third party payers of admissions when required.
Performs a comprehensive assessment including psychosocial problems, resources, deficits and continuing care needs.Develops and implements a plan, in conjunction with the patient, family and healthcare team, which addresses all problems and needs identified in the assessment.Provides clear, concise, timely documentation in the patient’s medical record.
Informs patients and their families on the use of community resources and advocates on their behalf when necessary.
Helps patients and their families to understand, accept and follow medical recommendations for post-hospital care.
Assists patients and their families/significant others to understand their insurance coverage and its limitations.
Participates in continuous quality improvement activities.
Performs data abstracting for core options.
Performs follow-up calls to select patients discharged to home, focusing on targeted diagnoses and referrals
Completes psycho-social assessments and develops action plans for all patients.
Routinely completes screening for depression, adjustment problems, anxiety/stress, and substance abuse as clinically indicated.Reports clinical findings to the physician for appropriate follow-up.
Identifies patient/family learning needs and directs teaching according to standards of care; manages multiple patient/family needs by utilizing knowledge base and experience.
Collaborates with physician/interdisciplinary team to meet patient outcomes.
Participates with various agencies in order to provide for needs of discharge patients.
Documents case management activities/intervention in the medical record utilizing approved documentation standards.
Collaborates with other clinicians and therapists as a member of the Interdisciplinary Team.
Participates in educating client/family/caregiver relative to the disease process and the impact of the illness on psychosocial factors.
Participates in performance improvement activities.
Performs other duties as assigned or directed.
BSW with a valid unrestricted Michigan license
Two (2) years BSW experience serving chronically ill patients and extensive knowledge of issues associated with chronic care, disability and geriatrics.
Familiar with initiatives of Managed Care Utilization Management, Medical Management and/or Case Management.
Ability to effectively manage multiple tasks, activities, and responsibilities.
Exemplary communication and presentation skills.
Ability to lead self-directed teams.
Commitment to collaborative practice.
Three (3) years MSW experience serving chronically ill patients and extensive knowledge of issues associated with chronic care, disability and geriatrics.
Two (2) years in Managed Care Utilization Management, Medical Management and/or Care Management experience.
Recent Case Management experience with Discharge Planning and Utilization Review.
Experience in a process improvement and multidisciplinary quality improvement area.
Certification specific to CM and/or UR.
Knowledge of licensing, accrediting, CMS, and third party payer requirements preferred.
Experience with diagnosis and procedure coding.
Proficiency with database, spreadsheet, and word processing programs.
Proficiency with research and data analysis.
Previous supervisory experience.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
Job: Health Professional
Primary Location: Michigan-Lansing-Ingham Internal Med Assoc
Organization MMG00-McLaren Medical Group - Admin
Employee Status Regular
Shift Day Job
Job Type Standard
Req ID: 20008425