RN Disharge Navigator

Employment Type:

Full time

Shift:

Description:

POSITION PURPOSE

The purpose of the RN-Discharge Navigator is to serve as a consistent care coordinator for MercyOne clinic patients being discharged from the hospital and emergency room. The coordinator will collaborate with the care coordination and clinical teams to assure the patient needs are met and all follow-up is transitioned to the ambulatory care team. The Navigator will be the liaison with the patient, providers, care team, family and other involved parties to identify and eliminate barriers to care to achieve an optimal clinical outcome. The coordinator will also serve as a resource for patients needing to establish care with MercyOne Clinics across the region.

ESSENTIAL FUNCTIONS

-Knows, understands, incorporates, and demonstrates the MercyOne (Trinity Health) Mission, Vision, Core Values, Actions and Promise in behaviors, practices, and decisions.

-Identifies problem areas in need of focused attention and implements actions to drive improved outcomes.

-Coordinates patient care in collaboration with the acute and ambulatory care team across the continuum of care.

-Manages the timely transition and follow-up post hospital discharges or emergency room visits ensuring appointments and follow up visits are scheduled.

-Ensure care documents and discharge notes are accessible to the ambulatory care team to ensure seamless transition and communication.

-Coordinates post hospitalization advanced imaging as needed, supporting communication with ambulatory care teams and ordering or tasking of discharge orders.

-Coordinates with clinic manager for access challenges and concerns to ensure timely follow-up. Escalates access concerns to Medical Group leadership.

-Identifies and refers patients appropriate for resource referrals including care management, high risk health coaching and community health workers.

-Document all patient coordination activities, education, and other interactions in designated inpatient and outpatient electronic health record systems to assure a timely, complete patient record and effective communication with other members of the care delivery team.

-Assist with tracking, documentation and outcome reporting for navigation services.

-Identify opportunities to develop improved processes and prevent hospitalizations, readmission and unnecessary emergency room visits.

-Supports patients in establishing care with MercyOne clinics and maintaining awareness of providers with access and limitations.

-Perform other duties consistent with the purpose of the job as directed.

MINIMUM QUALIFICATIONS

Education

• Bachelor's degree in nursing, health administration or related field required.

• Iowa licensure as a Registered Nurse.

Experience: Requires a minimum of three (3) years in clinical setting.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran