GENERAL SUMMARY OF DUTIES:
The Care Navigator (CN)
is accountable for assuring a high standard of quality and coordination of care, in support of HealthONE value based care (VBC) programs with payers in the market. The CN has a defined role, working in an advisory capacity to the RIHN practices, creating and monitoring standards of care, and providing support of the VBC programs. The CN supports the RIHN care navigator team, which may include physicians, nurses and social workers, in outreaching, triaging and if appropriate providing care navigation for patients in the VBC. DUTIES INCLUDE BUT NOT LIMITED TO:
- Conduct outbound calls to patients recently discharge from hospital or ER to ensure appropriate follow-up with primary care providers
- Conduct outreach and follow up in regards to patients that are high risk, have a gap score and gaps in care.
- Complete a standard assessment for clinical, behavioral and community needs, triage for additional support by licensed clinical staff and complete referrals to additional resources as needed
- Provide patient education relative to navigating the health care system and community resources
- Collaborate with providers and practice teams to communicate patient's needs and develop solutions to overcome barriers
- Maintain a case load of patients requiring care navigation support and document as appropriate
- Collaborate with the payer systems and payer Care Coordinators on specific patient care needs to include encouraging them to work with their applicable payer Case Manager, Disease Manager or Wellness Program designee.
- Supports the efforts of providersand practice teams on office based care delivery interventions resulting in cost of care savings and improvedhealth outcomes for patients.
- Test and pilot new VBC initiatives and work with leadership on refining processes, helping HOPP achieve contractual metrics.
- Review reports from payers and assist Director of Quality in the interpretation of the reports and actions needed
- Assist in the development, implementation and monitoring of corporate and/or HealthONE policies and procedures as they relate to VBC programs.
- When the need arises, will perform other duties as assigned by supervisor.
The requirements for the CN include, but are not limited to:
- LPN License, Medical Assistant Certificate or B.A./B.S. in health care related field coupled with 5 years health care experience in primary care, care management/coordination or other related field. Commensurate experience in public health, social services or other health care field may take the place of this requirement.
- Competence in the ability to triage patients over the phone and in person;
- Strong computer skills, particularly related to Microsoft applications Word, Access, Visio, Excel, PowerPoint and Outlook.
- Comfort with exploring and learning to use new or unfamiliar applications or databases.
- Working knowledge of health information technology
- Managed Care Understanding specifically ACO/Value Based Contracts
- Commitment to collaboration, professionalism, and effective communication in all interactions with physicians, HealthONE Physician Services employees, patients, caregivers and payers.