RN Care Navigator — Skilled Care Admissions & Plans

St. Joseph Hospital; Lewiston (ME); Hybrid; USD 63,000 - 87,000; Full time

Job summary

Covenant Health Ministry in Lewiston, ME seeks a Care Coordinator to assess admission referrals from acute care and other facilities, verify benefits, and ensure alignment with organizational goals before admission.

You will gather medical, financial and social data, coordinate with the care team, and develop comprehensive care plans while ensuring safe, compliant patient care and smooth discharge planning.

Qualifications

• Must be able to speak clearly, read, write, and comprehend the English language.
• Customer service, interpersonal, and organizational skills.
• Knowledge of Geriatric care desired.
• The ability to speak, read, write, and understand written instructions in English is required.
• Flexibility required to provide coverage 24 hours/day, 7 days per week. May be asked to float to other units.
• Computer skills
• Mathematical skills.
• Medical terminology required.
• Ability to multi-task and make decisions under pressure.
• Work alone and as part of a team.

Responsibilities

• Analyze clinical and financial data to identify suitable patients for placement according to organizational strategies.
• Provide prompt responses to referring facilities following analysis of placement appropriateness.
• Gather necessary medical, financial, and social information for patient care establishment.
• Disseminate admission information to the d'Youville team as needed and consult the medical team for referrals when necessary.
• Collaborate with patients and their significant others to establish admission goals and care plans.
• Develop and regularly update individualized, multidisciplinary care plans, incorporating age-specific knowledge.
• Review and document discharge plans/instructions with patients, and initiate referrals to available resources as needed.
• Conduct patient follow-up calls to ensure quality and satisfaction, administering satisfaction surveys.
• Act as a liaison for external agencies, coordinating with the interdisciplinary team for successful admissions.
• Ensure preparedness for patient needs, including medications, IV therapy, and equipment, upholding clinical standards and policies.

Skills

Communication

Customer service

Geriatric care

English language

Flexibility

Computer skills

Math skills

Medical terminology

Multi-tasking

Teamwork

Education

Licensed Practical Nurse (LPN)

BCLS

Job description

Job Summary:

Under the guidance of the Director of Nursing, the Care Coordinator will assess all admission referrals from acute care settings or other facilities. They will evaluate patients' skilled/Long Term Care requirements, verify eligibility benefits, and ensure alignment with organizational strategic goals before admitting them.

Essential Duties and Responsibilities

• Analyze clinical and financial data to identify suitable patients for placement according to organizational strategies.
• Provide prompt responses to referring facilities following analysis of placement appropriateness.
• Gather necessary medical, financial, and social information for patient care establishment.
• Disseminate admission information to the d’Youville team as needed and consult the medical team for referrals when necessary.
• Collaborate with patients and their significant others to establish admission goals and care plans.
• Develop and regularly update individualized, multidisciplinary care plans, incorporating age-specific knowledge.
• Review and document discharge plans/instructions with patients, and initiate referrals to available resources as needed.
• Conduct patient follow-up calls to ensure quality and satisfaction, administering satisfaction surveys.
• Act as a liaison for external agencies, coordinating with the interdisciplinary team for successful admissions.
• Ensure preparedness for patient needs, including medications, IV therapy, and equipment, upholding clinical standards and policies.
• Familiarize with acceptable diagnoses for admissions and reimbursement.
• Maintain patient safety through infection control measures and appropriate equipment use.
• Manage crisis periods calmly, coordinating discharge needs across all disciplines.
• Verify managed care company rates and insurance coverage, obtaining pre-certification for necessary equipment.
• Complete referral documentation and collect and prepare patient information for relevant departments.
• Document nursing care actions, observations, and patient responses, reporting changes promptly and accurately.
• Make referrals to external resources and communicate admission/discharge information to departments and physicians.
• Attend department meetings, serving as a resource and providing education in areas of expertise.
• Stay informed of field advancements, maintaining education/training logs.
• Adhere to infection control practices, utilizing gait belts as needed, and attend safety education sessions to promote safe practices.
• Understand and articulate organizational safety goals.

• Supports and promotes the mission and values of Covenant Health Ministry.
• Other duties as consistent with this role.

Job Requirements

Job Knowledge and Skills

• Must be able to speak clearly, read, write, and comprehend the English language.
• Customer service, interpersonal, and organizational skills.
• Knowledge of Geriatric care desired.
• The ability to speak, read, write, and understand written instructions in English is required.
• Flexibility required to provide coverage 24 hours/day, 7 days per week. May be asked to float to other units.
• Computer skills
• Mathematical skills.

Medical terminology required.

• Ability to multi-task and make decisions under pressure.
• Work alone and as part of a team.

Education and Experience

• 0-1 year of experience working with Geriatrics patients desired.
• Valid State of Maine Licensed Practical Nurse.
• BCLS

Covenant Health Mission Statement

We are a Catholic health ministry, providing healing and care for the whole person, in service to all in our communities.

Our Core Values:

•Compassion

We show respect, caring and sensitivity towards all, honoring the dignity of each person, especially the poor, vulnerable and suffering.

•Integrity

We promote justice and ethical behavior, and responsibly steward our human, financial and environmental resources.

•Collaboration

We work in partnership, dialogue and shared purpose to create healthy communities.

•Excellence

We deliver all services with the highest level of quality, while seeking creative innovation.

Applicants, employees and former employees are protected from employment discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age (40 or older), disability, and genetic information (including family medical history).

Comp Range:

$30.32 - $41.76

Rate of pay displayed reflects the beginning of the pay scale. At the time of an offer, determination of your offer will reflect your skills and experience as it relates to the position.