Ambulatory Care Navigator

Job Description Summary:

Serves as a liaison between the provider and patient between clinic visits. Communicates by phone (or in person if needed) when clinical concerns arise and provides transitional care after the patient visits the ED or hospital. Identifies and addresses barriers to care that might keep the patient from receiving timely and appropriate treatment as well as assists with identifying community resources. Meets weekly with the primary medical team to discuss current patients and identify new patients at risk for services. Participates in Transitional and Supportive Care rounds to help identify patients who are candidates for services.

Essential Functions

• Responsible for ongoing evaluation and quality improvement of the Navigator Program and tracks all activity as defined by the departmental and program standards.
• Ensures quality patient care by adhering to the policies of WFBMC, involving patients and their families in identifying their needs, creating a plan to meet those needs, and effectively communicating the plan across the continuum of care. Identifies barriers to efficient and effective management of patient care and seeks strategies to remove them.
• Implements outreach efforts to establish and maintain positive working relationships with key community agencies.
• Collects and maintains up to date and accurate program data and documentation according to program standards. Delivers reports that demonstrate outcomes and performance improvement activities; adheres to established productivity benchmarks.
• Trained in motivational interviewing and health coaching to provide chronic care management.
• Demonstrates ability to function in a professional practice model through active participation in shared governance and acceptance of personal responsibility for professional growth. Demonstrates responsibility for personal development by participating in continuing education offerings. Seeks new opportunities for self- improvement. Seeks and applies constructive feedback to improve performance.
• Provides age/developmentally appropriate patient care in accordance with Age-Specific guidelines for the specific age groups served.

SKILLS/QUALIFICATIONS: Problem solving, decision making and critical thinking skills Ability to work in a self-directed environment Ability to work with and lead teams Demonstrates ability to work in fast-paced environment with multiple interruptions Expertise in MS Office and ability to prepare program reports frequently and efficiently

WORK ENVIRONMENT: Clean, well-lit, comfortable environment Possible exposure to infections and contagious diseases Occasional exposure to patient illnesses Occasionally subject to irregular hours (evenings and weekends)

PHYSICAL REQUIREMENTS: 0% 35% 65% to to to 35% 65% 100% N/A Activity X Standing X Walking X Sitting X Bending X Reaching with arms X Finger and hand dexterity X Talking X Hearing X Seeing Lifting, carrying, pushing and or pulling: X 20 lbs. maximum X 50 lbs. maximum X 100 lbs. maximum

EDUCATION/EXPERIENCE:

• Graduation from an accredited School of Nursing.
• BSN required with two years' experience as a Registered Nurse. Case management experience preferred.
• Bilingual preference with fluency in Spanish preferred.

LICENSURE, CERTIFICATION, and/or REGISTRATION:

Current license as a Registered Nurse (RN) in the State of applicable state.