Nurse Navigator: Care Coordination & Patient Advocate

USA Health Systems; Mobile (AL); On-site; USD 60,000 - 75,000; Full time

Benefits offered by this job

Benefits eligibility

Job summary

USA Health is transforming medicine along the Gulf Coast, seeking a licensed nurse to provide dedicated clinical oversight to a specific patient population within a department on the Gulf Coast. You will serve as the intermediary across service lines to ensure the patient care plan remains intact and centered on the patient throughout the disease process and transitions.

In this role, you will assist the provider in outpatient clinic management, participate in direct patient care activities,

Qualifications

• Graduation from an accredited school of nursing meeting the minimum standards set by the state of Alabama and 3 years of related experience Required
• Masters will substitute for one year of the required experience Preferred
• LPN - Licensed Practical Nurse - State Licensure Required or
• RN - Registered Nurse - State Licensure and/or Compact State Licensure in accordance with the Nurse Licensure Compact (NLC) for Alabama Required

Responsibilities

• To provide dedicated clinical oversight to a specific vulnerable patient population within a department.
• This role serves as the intermediary between multiple service lines and pathways to ensure the patient care plan remains intact and patient centered throughout the disease process and their care transitions.
• Assists the provider in the medical management of outpatients in the clinic
• Participates in direct patient care activities including but not limited to assessments, vital signs, specialty specific procedures/testing, injections, wound care, and phlebotomy
• Manages calls and messages from patients, families, other health care providers and pharmacies to ensure patient’s needs, questions and treatments are addressed in a timely fashion
• Communicates with overseeing provider to receive orders for prescriptions, medical equipment, home health/hospice etc. and obtain insurance authorizations as required
• Serves as the primary contact point, advocate, and informational resource for patients, care team, family/caregiver(s), payers, and community resources
• Provides education and information to the patient and caregiver(s) related to their ongoing plan of care including current medications (including side effects), diagnostic schedules, follow-up schedules, and symptom management
• Documents patient teaching including family and others, based on assessment of needs and respond to patient request
• Assist in coordination of care for the patient and caregiver(s) and provides emotional support
• Cultivates and supports primary care and specialty provider co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals
• Works across health care disciplines to assist in coordinating patient tests, procedures, appointments, and treatments, and assist patients in overcoming barriers to care including, but not limited to, transportation, financial counseling, and referrals
• Refers patients for supportive care services including nutritionists, social workers, counselors, and financial counselors
• Establishes referral processes for each clinical area mentioned above
• Monitors the patient through their care in the system including in working with the patient and caregiver(s) while inpatient to ensure the plan of care is clear and continues after discharge
• Rounds on patient as needed for plan of care update and education purposes
• Continuously educates patient and caregivers during any transitions of care including but not limited to inpatient/outpatient stay, procedure/surgical care, rehab admission or discharge, or other specialty clinic care
• Works with providers to monitor patient population to analyze care plans, resources provided, and find opportunities to develop new tools or care pathways to serve the patients

Job description

USA Health is transforming medicine along the Gulf Coast, seeking a licensed nurse to provide dedicated clinical oversight to a specific patient population within a department on the Gulf Coast. You will serve as the intermediary across service lines to ensure the patient care plan remains intact and centered on the patient throughout the disease process and transitions.

In this role, you will assist the provider in outpatient clinic management, participate in direct patient care activities,