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- Conduct Transitions of Care Management for a subset of the patient population, including ER and hospital follow ups
- Provide triage guidance and supportive consultation to other team members, handling escalated complex cases
- Develop care plans leveraging 5Ms Geriatric best practice framework
- Develop a wholistic view of patient needs related to Social Determinants of Health
- Identify existing barriers to engagement with necessary resources and supports
- Provide education around maintenance of chronic health conditions, as well as available options for behavioral care and social support
- Serve as liaison between the patient and the direct care providers, assisting in navigating both internal and external systems
- Initiate care planning and subsequent action steps for high-risk members, coordinating with interdisciplinary team
- Supporting patients self-determination, motivate patients to meet the health goals they have identified
- Refer patient to necessary services and supports
- Registered Nurse (RN license)
- Minimum of 4 years of experience working in human services and navigating community-based resources
- 401(k)
- 401(k)
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Parental leave
- Vision insurance
- Geriatrics
- Primary Care
- Acute care
- Clinic
- Hospital
- Inpatient
- Long term care
- Nursing home
- Rehabilitation center
- Day shift
- Yearly bonus
- 5x8
- Monday to Friday
- RN License (Required)
- Belle Glade, FL 33430: Relocate before starting work (Required)
RN Care Navigator - Belle Glade, United States - Conviva
Description
Working within an interdisciplinary care team, the Care Navigator is responsible for proactively engaging patients identified as high-risk and implementing targeted interventions to address social needs and increase access to care.
The Care Navigator will provide guidance and oversight of care coordination efforts to other members of the team, and handle clinical escalations as indicated.
This role has a mobile presence, involving travel to patients homes, treatment facilities and community-based settings, and assigned clinics to facilitate and foster connections.
Job Type:
Full-time
Pay:
$80, $90,000.00 per year
Benefits:
Medical specialties:
Physical setting:
Standard shift:
Supplemental pay types:
Weekly schedule:
Experience:
Human Services: 4 years (Required)
License/Certification:
Ability to Relocate:
Work Location:
In person