Chronic Care Navigator - Titusville, United States - Parrish Medical Center

Description

Department:
Care Transitions

Schedule/Status:
Varies; Full Time

Standard Hours/Week:
40

Location:
Titusville

General Description:
Under the general supervision of Neuro-diagnostic Manager, the Navigator is responsible for fulfilling the Parrish Medical Center mission, vision and values; navigating patients with new or ongoing chronic health conditions in a manner that results in effective care coordination and testing through the continuum and increase treatment compliance to maximize overall patient care experience and outcomes. The Navigator serves as the first point of contact for referring providers, patients, DME companies, or other key integrated care partners. The navigator will follow patient adherence to treatment and plan of care set upon their discharge. The navigator will monitor readmissions and provide ongoing measurable outcomes. The position shall exemplify the desired Culture of Choice and philosophies of Parrish Healthcare.

Key Responsibilities:

• Responsible for promoting and demonstrating Parrish Healthcare's Culture of Choice. Ensures goals and objectives are met or exceeded by providing effective Respiratory and Sleep Care Navigation.
• Improves coordination of care and testing and increases treatment compliance to maximize the overall patient care experience and outcomes. Includes but is not limited to partnering with patients and families to ensure understanding of care plan and initiating referral generation; providing timely follow up with patients and providers to successfully coordinate care plan.
• Coordinates care plan delivery between the patient, referring providers, home health, skilled nursing, DME company and other key integrated care partners.
• Facilitates Works the patient to determine social needs, barriers to care plan and navigates the patient to the appropriate resources.
• Identify patients support team and Physician care team to assess risk and determine social needs.
• Follow patient in multidisciplinary transitional care, disease management, or home visit program as needed.
• Collaborates with the Integrated care team within the Parrish Health Network to identify patients at risk for readmissions based on chronic conditions, social barriers or risk status.
• Completes health literacy assessment and monitors progress on patient identified self-management goals.
• Performs similar or related duties as assigned.
• Knows fire, disaster and safety procedures and regulations as pertains to the work area.
• Indicates an "essential" job function.

Requirements:

Formal Education:

• Associate degree in healthcare related field required. Bachelor's degree preferred.

Work Experience:

• 2 years to < 3 years.

Required Licenses, Certifications, Registrations:

• Licensed as an, RN, or RRT. Registered PSGT preferred.
• Prefer certification as an Asthma/COPD Educator, Clinical Sleep Educator (CCSH).
• BCLS through the American Heart Association required.

Parrish Healthcare is a caring community of healthcare professionals passionate about excellence and fulfilling our mission of providing Healing Experiences For Everyone All The Time.

Parrish Healthcare has a Culture of Choice. This means a we have a healing work environment that empowers people to aspire to be their very best. We partner passionate, talented and skilled people in the right role with the right resources. We provide a clear and strategic direction to achieve superior results on behalf of the communities we serve.