RN Transitional Care Navigator (Population Health) – Transitions of Care Program – Days
- Skokie, IL
- Permanent
- Full-time
- Position: RN Transitional Care Navigator (Population Health) – Transitions of Care Program – Days
- Location: 4901 Searle Parkway, Skokie (Corporate Office)
- Full Time: 40 hours/week
- Hours: Monday – Friday (8:30 am -5:00 pm), 2 days onsite required and 3 days remote optional. Weekend and holiday required per rotation. Remote optional for weekend and holiday coverage.
- Guides high-risk patient and family through the health system from diagnosis, testing, treatment and follow-up care to assist patients with navigating the continuum of care. Eliminates barriers to patient's access to health care services and facilitates continuity of care/care coordination.
- Establishes and documents an individualized plan of care for assigned patients using evidence-based treatment guidelines considering the patients individual health goals with a focus on wellness, health management, disease prevention and chronic disease management.
- Partners with the healthcare team to ensure clinical decision-making, implementation of recommendations, and discharge planning are timely and appropriate.
- Performs daily coordination between multiple departments, multi-disciplinary team, medical clinics, and community outreach to gain knowledge of patient, assure patient safety, smooth transitions of care, and manage utilization and total cost of care.
- Acts as advisor/educator by partnering with social work in providing emotional support including goals of care and counseling. Provides and/or arranges clinical education including medication management, community resources, financial resources, and expert guidance to patients and families to promote their ability to understand and meaningfully participate in the healthcare process and personal decision-making.
- Facilitates appointments for appropriate consultations and support services within established protocols
- Completes Utilization Management for assigned patients.
- Applies Milliman Care Guidelines (Indicia) criteria to monitor appropriateness of admissions and continued stays and documents findings based on Department standards.
- Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
- Bachelor’s degree in healthcare or related field required or minimum of seven (7) years of appropriate experience as noted below.
- Bachelor’s degree in Nursing from an NLN accredited school of nursing is preferred.
- Clinical certification, such as case management certification, ambulatory care nursing certification is preferred.
- Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross) is preferred.
- Minimum three (3) years of utilization review, discharge planning, case management or disease management preferred.
- Nursing experience in home services, ambulatory services working with high-risk patients beneficial.
- 2+ years of clinical nursing experience preferred.
- Adheres to and practices in alignment with contemporary standards of care as established by leading professional organizations, including but not limited to the American Academy of Ambulatory Care Nursing (AAACN), the American Case Management Association (ACMA), and the Case Management Society of America (CMSA).
- Interacts with and contributes to professional development of peers and other health care providers as colleagues.
- Shares knowledge and provides feedback with peers to contribute to an environment supportive of clinical education.
- Knowledge of InterQual or MCG criteria preferred.
- Able to communicate and work collaboratively with a range of stakeholders and team members.
- Knowledge of community resources.
- Experience with Microsoft Office Suite.
- Strong interpersonal and oral communication skills.
- Strong computer and data entry skills.
- Experience with Electronic Medical Record (EMR) platform preferred.
- Proven leadership skills.
- Ability to work independently, setting priorities to coordinate care plan efficiently.
- Premium pay for eligible employees
- Career Pathways to Promote Professional Growth and Development
- Various Medical, Dental, Pet and Vision options
- Tuition Reimbursement
- Free Parking
- Wellness Program Savings Plan
- Health Savings Account Options
- Retirement Options with Company Match
- Paid Time Off and Holiday Pay
- Community Involvement Opportunities