Description

PURPOSE:

The patient navigator reports to the Case Management Manager and is responsible for ensuring that the needs of the patients are met from a referral and authorization standpoint. Patient navigators also address social needs and help to provide resources on an individual basis in accordance with policies and procedures, guidelines, regulations, and current federal, state, and local standards. This is a patient facing position and involves collaboration with the care team and patients to ensure quality care.

DIMENSIONS:

The Patient Navigator will work directly with patients to coordinate safe and effective care. The employee will participate in the development of organization objectives and participate in quality assessment and improvement processes and activities. 

The Patient Navigator will protect the dignity, privacy and confidentiality of patients and their families, as well as co-workers and others.

Lincoln Health supports and encourages a multidisciplinary team approach to whole person patient centered care with the integration of primary care and

behavioral health services.

ENVIRONMENT:

Lincoln Health is a 15-bed Critical Access Hospital co-located with 22-bed Long Term Care Unit. The facility employs 150-200 employees. 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. This is an in person direct patient care position, working closely with the care team as well to coordinate care for patients.
2. Works directly with insurance companies to obtain prior authorizations for services for patients.
3. Patient Navigators use multiple different computer systems to authorize, track, and submit referrals.
4. Patient navigators work to facilitate patient care by assessing patient needs, evaluating treatment options, accessing resources, coordinating care, and gauging progress. 
5. This position is a member of the case management team. The case management team is responsible for assisting and navigating patients throughout the continuum of care and aids in navigating the health care system.
6. Assists patients and their families (in their social, racial, ethnic, and cultural context) cope with the immediate effects of the decision to move to the facility and/or inpatient stay. 
7. Orients patients and families to the facility, its services, its service limitations, and patients' rights.
8. Provides linkage with appropriate community resources by maintaining knowledge of other systems, making referrals, and identifying unmet needs (e.g., recreational transportation, adaptive phone equipment, etc.) 
9. Provides Advance Directive Information and forms. 
10. Assists with planning discharges/transfers to ensure appropriateness and continuity of care for transfers within and discharges from the facility. 
11. Assists in developing a comprehensive discharge plan in collaboration with patients, families, multidisciplinary staff, and referral agencies which identifies resident needs and preferences.  
12. Completes referrals, prior authorizations, and necessary documentation to coordinate care among other departments and/or other facilities. 
13. The patient navigator is responsible for swing bed admission planning, swing bed admission and discharge.
14. Completes mandatory documentation within timelines established by applicable regulations.
15. Completes applicable Medicare/Medicaid information with patients and residents to facilitate patient admission to skilled nursing, assisted living or other living situations.
16. Performs other duties as assigned. 

EXPOSURE RISK:

The is at risk for exposure to blood and body fluids or other potentially infectious materials.

SUPERVISORY RESPONISIBILITIES:

NONE

QUALIFICATION REQUIREMENTS:

Must be willing to spend most of the day working directly with patients and helping them with their needs.

Must have excellent communication skills.

Must have great customer service and positive attitude.

Must possess a working knowledge of health care regulations and a willingness to learn job specific skills. 

Must be able to function independently and have flexibility, personal integrity, and the ability to collaborate effectively with patients, staff, and support agencies. 

Must be able to relate to and work with ill, disabled, elderly, emotionally upset, and at times hostile people within the facility. 

Must possess the ability to make independent decisions when circumstances warrant such action. 

Must be able to enter and retrieve data using computer systems, systems applications, and other office equipment. 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE:

High School Diploma or equivalent required. Excellent communication skills required. At least one year of experience working preferred. Healthcare experience preferred.

LANGUAGE SKILLS:

Solid oral and written communication skills

REASONING ABILITY:

Ability to work in a fast-paced environment.

Ability to communicate effectively on the phone and in person with others.

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. 

OTHER SKILLS AND ABILITIES:

Ability to use a computer and learn software for organization.

Critical thinking skills

Ability to multi-task and be flexible with job demands.

Energetic, motivated individual that connects well with people.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

While performing the duties of this job, the employee is regularly required to use hands to finger, handle or feel objects, tools, or controls; reach with hands or arms; and talk and hear. The employee frequently is required to sit, kneel, and stoop. The employee is occasionally required to stand and walk.

The employee must frequently lift and/or move up to ten (10) pounds and occasionally lift and/or move up to twenty-five (25) pounds. Specific vision abilities required by this job include distance vision and the ability to adjust focus. 

WORK ENVIRONMENT:

Normal well-lit confidential office environment where there is no physical discomfort due to temperature, dust, noise, and the like. May be required to meet with patients and/or staff in different settings within the facility.

MEASURES OF EFFECTIVENESS 

The indicators of proficient performance in this position are carrying out all the items specified in the “Essential Duties and Responsibilities” as listed above.

Requirements

QUALIFICATIONS:

Must possess a working knowledge of health care regulations and a willingness to learn job specific skills.

Must be able to function independently and have flexibility, personal integrity, and the ability to collaborate effectively with patients, staff, and support agencies.

Must be able to relate to and work with ill, disabled, elderly, emotionally upset, and at times hostile people within the facility.

Must possess the ability to make independent decisions when circumstances warrant such action.

Must be able to enter and retrieve data using computer systems, systems applications, and other office equipment.

Must be willing to spend most of the day working on computers and on the phone.

Must have excellent communication skills.

Must have great customer service and positive attitude.