- Provides screening interviews, appropriate linkages, referrals, coordination, and follow-up for identified patients. Works with the Care Manager and Social worker for Health Home referrals and overall navigation of patient services.
- Coordinates follow-up discharge appointments with patient's Primary Care Physician/Specialist/Mental Health Provider for high risk patients within required time frames either prior to or within 24-72 hours after discharge from ED depending on the high risk need. Completes documentation for navigation, health home referrals and discharge appointments.
- Assures timely electronic transmission of ED assessments, discharge summaries and other pertinent information to the patient's PCP and/or Specialist when indicated.
- Coordinates the transfer, data collection and reporting electronically for navigation responsibilities.
- Prepares agendas, minutes and any required materials for specific navigation processes and Readmission meetings.
- Works with the Care Manager to link patients to agencies that provide transportation, translation services, financial support, and other needed services to ensure follow-up with PCP/PCMH/ Specialist.
- Collaborates with multi-disciplinary team, including clinical and non-clinical, and works with other team members to provide proactive outreach and support to patients including access to
medications as needed under the direction of the care manager and/or provider. - Provides educational resources to patients on preventable ED visits in collaboration with the Care Manager or other appropriate clinical staff.
- Completes follow-up with patients and/or PCP/PCMH staff as needed to assure completion of
post-ED visit. - Exhibits knowledge and skill in all functions of the electronic medical record pertinent to
successful job performance. - Compiles data and statistics as directed to illustrate referral activities and referral elements required.
- .Ensures and/or remains in compliance with local, state, and federal regulations.
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Infinity Systems Saratoga Springs, NY, United States Freelance**Your Profile** · - **You know what matters** - You have completed a 3-year vocational training in the field of nursing and have experience in caring for critically ill clients. · - Ideally, you have the qualification as responsible nursing specialist according to §71 SGB XI or ...
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Navigator - Care Management - Saratoga Springs, United States - Saratoga Hospital
Description
Summary of Position: This position is responsible to coordinate with care managers and social workers to provide community linkages, referrals, coordination, discharge appointments, PCP identification/ appointment referral and follow up for identified high risk patients. The navigator will assist with patient screening interviews, data collection on referrals and work with the care management team to facilitate communications to community resources, facilitate transportation needs and support new and existing projects. The Navigator is responsible for coordinating services for identified patients to ensure access to appropriate primary care and specialist care services after discharge from the ED and/or inpatient nursing units. The navigator would also assist care managers/ social workers with referrals for DME, screening for skilled nursing facilities and overall navigation services.Primary Job Responsibilities:
Salary Range: $ $33.70
Pay Grade: 24
Compensation may vary based upon, but not limited to: overall experience and qualifications, shift, and location.
