Transitional Care Navigator

Position Purpose

Under the supervision of the department leadership this position uses a collaborative process that assesses, plans, coordinates, monitors, and evaluates post discharge options and services for patients based on available community resources and health insurance benefits. Medical necessity evaluations are made based on nationally recognized criteria for all prior authorizations, admissions, and concurrent reviews and in coordination with the Senior Clinical Leader.

The navigator works collaboratively with the acute and transitional care facility discharge planning teams to direct patients to contacted providers and identify and implement placement of services to facilitate successful patient outcomes. Transitional care navigators coordinate with other team members to ensure the patients experience exceeds expectations.

This position serves as an integrated member of the clinical care team and provides post-acute and post transitional services to patients and families to determine and coordinate the appropriate level of care and/or services.

Nature and Scope

This position has the responsibility to promote care coordination activities to provide for individual patient’s health care needs through the continuum of care. This position collaborates with all medical team members throughout the continuum and educates the patient/family on managed care issues, community resources and plan benefits. Patient communication may be conducted via telephone, virtual, face to face or in the home or facility setting.

This collaboration promotes positive outcomes (quality) and the utilization of patient care resources in an efficient and cost-effective manner within the benefit structure.

Knowledge, Skills, and Abilities:

Serves as a contact at hospitals and transitional care facilities and advocates for patients and families to ensure coordination of post-acute services. Provides support to the patient and family by listening and responding to their question/concerns and by guiding them through the discharge process for the acute and transitional care settings.

· Provides post discharge care coordination from hospitals and/ or transitional care facilities assuring effective transition back to the outpatient environment. These care coordination visits conducted via telephone, virtual or face to face in the home or facility setting.

· Educates patients and families in understanding their diagnosis, treatment options, and resources available to them.

· Utilizes clinical criteria to refer patients to appropriate resources for services or care and coordinates the process of obtaining referrals to those resources for patients and their families.

· Promotes effective utilization of healthcare resources for placement in the appropriate care level post discharge by facilitating implementation of and updates to patient’s discharge plan. Works collaboratively with interdisciplinary healthcare team to achieve optimal clinical outcomes.

· Provides education and consultation to physicians and other health care providers regarding resources and services available to patients.

· Collaborates with physicians, patients, and families in the after-care planning process. Coordinates team efforts to ensure all critical elements have been communicated to the patient/family.

· Documents care planning activities and reviews data to ensure accuracy. Reviews processes with the goal of improving the clinical experience for referred patients and their physician. Works collaboratively with Renown Health teams to facilitate any needed changes.

· Monitors regulatory issues and requirements regarding potential denial of benefits and provide information to appropriate individual.

· Intervenes to avoid concurrent denial of services by planning care and discharge with clinical team. Demonstrates the knowledge and skills necessary to evaluate post-acute needs, based upon physical, motor/sensory, psychosocial, and safety appropriate to the age of the patient served.

This position does not provide patient care.

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications

Requirements - Required and/or Preferred