RN Patient Navigator, Utilization Review - Full Time

Mercyhealth Wisconsin and Illinois; Rockford (IL); Hybrid; USD 54,000 - 83,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Life & Disability Insurance

FSA/HSA Options

Generous PTO

Job summary

Mercyhealth is seeking an RN Patient Navigator to coordinate and facilitate patient care, ensuring appropriate services and efficient use of resources across the health care continuum.

The role includes early patient assessment, discharge planning, referrals to post-hospital providers, patient education, and collaboration with nurses and physicians to meet core measures and timely discharge, serving northern Illinois and southern Wisconsin.

Qualifications

• Graduate of an accredited nursing program.
• BSN or enrollment in BSN Completion Program.
• May require department-specific experience.

Responsibilities

• Provides case management, advocacy, and care coordination to hospital patients to ensure seamless transitions and minimize readmission risk.
• Conducts early patient assessment to identify coordination and discharge planning needs.
• Creates individualized plan for continuing care needs.
• Makes referrals to post-hospital providers leveraging community resources.
• Collaborates with the care team to ensure timely discharge, complete education, and follow-up.

Skills

Case management

Advocacy

Care coordination

Nursing knowledge

Patient education

Education

BSN

BSN completion program

Tools

Allscripts Care Management

Epic EMR

Outlook

Excel

Word

Job description

OVERVIEW

The RN Patient Navigator coordinates and facilitates patient care activities to assure appropriateness of services and efficient utilization of resources, improve coordination of care across the health care continuum, and to contribute to improved patient satisfaction and outcomes

Schedule: 40 hours/week - Potential hybrid schedule after initial training

Shift: Days

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Provides case management, advocacy, and care coordination services to hospital patients in a variety of settings to assure seamless transitions in care while minimizing any associated delays or risk of readmission.
• Conducts early patient assessment, by case-finding and referral, to identify coordination and discharge planning needs.
• Creates individualized, patient -focused plan for meeting continuing care needs.
• Makes referrals to post-hospital care providers utilizing knowledge of community resources.
• Collaborates with the healthcare team to ensure discharge is timely, patient education and instructions are complete, and appropriate follow-up is established.
• Utilizes current clinical nursing knowledge to effectively educate patients and families about chronic disease conditions.
• Collaborates with staff nurses and physicians to ensure all elements for core measures have been met prior to discharge.
• Conducts clinical review process according to Utilization Management Plan.
• Identifies and intervenes in situations that pose financial risk to the patient and the organization.

EDUCATION AND/OR EXPERIENCE

Graduate of an accredited nursing program.

- BSN or upon hire BSN completion agreement for enrollment in an accredited BSN Completion Program

May require specific years of applicable experience to qualify (per department guidelines).

CERTIFICATION/LICENSURE

Current Registered Nurse License in the state of practice.

- Dual Licensure (Wisconsin and Illinois) Preferred
Case Management Certification (ACM) preferred.
Certification preferred within three years to a specialty approved by CNO or designee; i.e.; Case Management, Med/Surg or Diabetic Education.

BLS/CPR required within 90 days

OTHER SKILLS AND ABILITIES

May include color blind test (per department guidelines)
Must be skilled with use of voice mail and phone features. Must be able to use available technology for language interpretation.
Must have expert knowledge of Allscripts Care Management program and Epic EMR. Must be able to use Microsoft Outlook, and have basic knowledge of Excel and Word. Must be able to easily toggle between computer applications.
Must be available to work and or be on-call on weekends and holidays, as assigned. On-call requires accessibility by pager or cell phone during assigned hours and ability to respond promptly to pages by phone.

LEVEL OF SUPERVISION

Assignments are based on abilities and are normally received in the form of results expected and due dates. Only general procedures are available to guide work. Must be able to work independently with minimal guidance.

SUPERVISES

This job has no supervisory responsibilities.

PAY RANGE

$38.80 - $60.14

Mercyhealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or protected veteran status.

Mercyhealth offers competitive pay and a comprehensive benefits package including:

• Medical, Dental, Vision
• Life & Disability Insurance
• FSA/HSA Options
• Generous, accruing paid time off
• Paid Parental and caregiver leave
• Career advancement and educational opportunities
• Tuition and certification reimbursement
• Certification Reimbursement
• Well-being Programs
• Employee Discounts
• On-Demand Pay
• Financial Education
• Annual recognition/awards events
• Partner appreciation days
• Family entertainment/attractions discount
• Community service/improvement opportunities

At Mercyhealth, we don’t simply hire people, we empower employee-partners who are passionate about making lives better. As an integrated health system, we deliver exceptional, coordinated across seven hospitals, 85 primary and specialty clinics, and a team of over 7,500 professionals serving northern Illinois and southern Wisconsin.

Mercyhealth has been nationally recognized for our people and culture, including:

• #1 in the nation on AARP's Best Employers for Workers Over 50
• One of Working Mother magazine's 100 Best Companies for Working Mothers
• A Top 50 Company and Top 10 Nonprofit for Executive Women