RN Transitional Care Navigator- Chronic and Complex Care Management Program-1

NorthShore University HealthSystem; Skokie (IL); On-site; USD 55,000 - 87,000; Full time

Benefits offered by this job

Premium pay for eligible employees

Career Pathways—growth opportunities

Tuition Reimbursement

Free Parking

Job summary

Endeavor Health in Skokie, IL is seeking an experienced RN Transitional Care Navigator to support population health through case management, care coordination, and utilization management. The role focuses on guiding patients across care settings and optimizing transitions to improve outcomes and cost efficiency.

You will work with a multidisciplinary team, document individualized plans, and help patients access resources while meeting performance metrics related to readmission rates and LOS

Qualifications

• RN license in Illinois or eligible for licensure
• Bachelor's degree in healthcare administration required; nursing degree preferred
• Minimum 3 years in utilization review, discharge planning, case management or disease management
• Experience with high-risk patient populations and home/ambulatory care settings beneficial
• Strong communication and collaboration with multidisciplinary teams
• Clinical certification in case management or ambulatory care nursing preferred
• Knowledge of InterQual or MCG criteria preferred
• Proficient with EMR and data entry

Responsibilities

• Guide high-risk patients and families through diagnosis, testing, treatment and follow-up to navigate the continuum of care
• Develop individualized care plans using evidence-based guidelines
• Collaborate with healthcare team to ensure timely decisions and discharge planning
• Coordinate daily between departments and community partners to ensure safe transitions and manage costs
• Provide education on medications, resources, and goals of care to patients and families
• Arrange referrals and appointments within established protocols
• Perform Utilization Management, monitor admissions and LOS, document findings

Skills

RN

Care coordination

Discharge planning

Case management

Communication

Data entry

EMR

Microsoft Office

Education

Bachelor's Degree Healthcare Administration

Bachelor's Degree Nursing

Tools

EMR system

Microsoft Office Suite

Job description

Hourly Pay Range:

$40.45 - $62.70 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.

Position Highlights:

• Position: RN Transitional Care Navigator (CCM)
• Location: Skokie, IL
• Full Time: 40 hours per week
• Hours: Monday-Friday, 8:00a-4:30p with rotating weekends and holidays

A Brief Overview:

The RN Transitional Care Navigator (Population Health) is responsible for the case management, care coordination management, and utilization management of his/her population of patients across multiple care levels and settings. Serves as a catalyst to promote patients understanding their diagnosis, treatment options, and available resources and ensure that they are connected with the optimal resources across the continuum of care. This role will coordinate and facilitate smooth and safe care transitions while ensuring quality cost-effective patient outcomes. Serves as a liaison between their patient population and all other providers. Will be responsible for key metrics of success, which include improving the overall cost of care, length of stay optimization, reduction in excess days, reduction in SNF utilization and improvement in SNF care transitions, reduction in 30-day readmission rate and ED utilization.

What you will do:

• Guides high-risk patient and family through the health system from diagnosis, testing, treatment and follow-up care to assist patients with navigating the continuum of care. Eliminates barriers to patient's access to health care services and facilitates continuity of care/care coordination.
• Establishes and documents an individualized plan of care for assigned patients using evidence-based treatment guidelines considering the patients individual health goals with a focus on wellness, health management, disease prevention and chronic disease management.
• Partners with the healthcare team to ensure clinical decision-making, implementation of recommendations, and discharge planning are timely and appropriate.
• Performs daily coordination between multiple departments, multi-disciplinary team, medical clinics, and community outreach to gain knowledge of patient, assure patient safety, smooth transitions of care, and manage utilization and total cost of care.
• Acts as advisor/educator by partnering with social work in providing emotional support including goals of care and counseling. Provides and/or arranges clinical education including medication management, community resources, financial resources, and expert guidance to patients and families to promote their ability to understand and meaningfully participate in the healthcare process and personal decision-making.
• Facilitates appointments for appropriate consultations and support services within established protocols
• Completes Utilization Management for assigned patients.
  1. Applies Milliman Care Guidelines (Indicia) criteria to monitor appropriateness of admissions and continued stays and documents findings based on Department standards.
  2. Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
• May need to travel to visit the patient at home from time to time.
• Available to his/her assigned patient population and participates as part of a call coverage structure.
• Participates in the collection and analysis of data to identify under/over utilization; improve resource consumption; promote potential reduction in cost; and enhance quality of care consistent with organization strategic goals and objectives.

What you will need:

• Bachelors Degree Healthcare Administration Required
• Bachelors Degree Nursing Preferred
• 3 Years Minimum three (3) years of utilization review, discharge planning, case management or disease management preferred. And
• Nursing experience in home services, ambulatory services working with high-risk patients beneficial. And
• 2 Years 2+ years of clinical nursing experience preferred
• Adheres to and practices in alignment with contemporary standards of care as established by leading professional organizations, including but not limited to the American Academy of Ambulatory Care Nursing (AAACN), the American Case Management Association (ACMA), and the Case Management Society of America (CMSA).
• Interacts with and contributes to professional development of peers and other health care providers as colleagues. Shares knowledge and provides feedback with peers to contribute to an environment supportive of clinical education.
• Knowledge of InterQual or MCG criteria preferred
• Clinical certification, such as case management certification, is beneficial.
• Able to communicate and work collaboratively with a range of stakeholders and team members
• Knowledge of community resources
• Experience with Microsoft Office Suite
• Strong interpersonal and oral communication skills
• Strong computer and data entry skills
• Experience with Electronic Medical Record (EMR) platform preferred
• Proven leadership skills
• Ability to work independently, setting priorities to coordinate care plan efficiently
• Registered Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) Required And
• BLS - Basic Life Support (CPR and AED) - American Heart Association (AHA) Preferred
• Clinical certification, such as case management certification, ambulatory care nursing certification Preferred

Benefits (for full and part-time positions):

• Premium pay for eligible employees
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, and Vision options
• Tuition Reimbursement
• Free Parking at designated locations
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off
• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

At Endeavor Health, we are united by a shared commitment to working together to create a culture of connection and belonging-each of us bringing different skills and experiences as we deliver safe, seamless, and personal care. Every person, every time. We are committed to fostering an environment where all team members can be their best, learn, and pursue excellence together.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.