Patient Navigator- Care Management (Full Time/ Days)

LOCATION: Lancaster, PA - Duke Street

HOURS: Full Time (40 hours per week). Monday-Friday (8am-4:30pm). No evenings, weekends or holidays 

Summary:

The Patient Navigator PN will be an integral member of the Care Management multi-disciplinary outreach team. Together with Care Managers, Social Workers and providers, the PN will assist in care plan development and implementation, provide advocacy to patients, help develop care management strategy for enrolled patients and help create linkages for the various health and social needs of patients. The Patient Navigator will be the direct contact for patients enrolled in the program and will help provide the coaching necessary for identified patients to achieve success in implementing and achieving their healthcare goals. The PN will be responsible for leading the multi-disciplinary team meetings huddles and implementing suggested approaches to providing better care. The PN will meet the patients in all settings including home, inpatient, outpatient and specialty office settings, as appropriate.

Qualified individuals must have the ability with or without reasonable accommodation to perform the following duties:

• Works under the direction of the care team; determines plans for care management; coordinates care plans and completes tasks as necessary to complete social behavioral care plan goals. Tasks may include, but are not limited to:
• Coordination of public assistance entitlements
• Coordination of behavioral health services
• Triaging after hours questions from enrolled patients as appropriate
• Accompanying patients to appointments as needed
• Arranging referrals to any additional services e.g. supportive housing programs, legal aid, etc.
• Assists patients in learning medication adherence systems, as well as conducting medication reconciliations as appropriate
• Acts as a liaison between the Emergency Department, specialists, community resources and managed care insurance plans on behalf of enrolled patients to ensure patient-centered coordination of care.
• Engages in the coaching of patients and caregivers on health literacy as determined necessary in achieving identified goals.
• Forges and nurtures partnerships with local service organizations and community resources to broaden support services for patients.
• Enters and maintains electronic records, compiles reports and completes other program documentation and administrative responsibilities in a timely manner e.g. progress notes, incident reports, client track, letters, etc. 
• Participates in interdisciplinary case conferences team meetings huddles.
• Plays a consistent and active role in identifying project inefficiencies and finding collaborative solutions to the problems.

The following duties are considered secondary to the primary duties listed above:

• Participate in the education of nursing and medical students that may rotate through the Care Connections Clinic.
• Comply with OSHA, HIPPA and other mandated safety procedures or regulations.
• Attend meetings run by community organizations as deemed necessary
• Attend continuing education classes or conferences as deemed necessary
• Participates in the on-call responsibilities for this position as required.
• Other duties as assigned.