RN - LEAD NURSE NAVIGATOR

Responsibilities

Job Summary:  The ACO Nurse Navigator Lead is a registered nurse operating in a leadership role overseeing a team of Nurse Navigators. ACO Nurse Navigators are liaisons between the ACO, the patient and the multidisciplinary healthcare team to assist in developing an optimal plan of care for transitioning Medicare patients, primarily those being discharged from hospital inpatient or emergency department services. The ACO Nurse Navigator Lead provides both administrative and operational guidance and support to the LVN Nurse Navigators, training and accountability for routine expectations, and clinical oversight where necessary. The ACO Nurse Navigator Lead will also facilitate case conferences engaging post-acute care providers and primary care providers to develop and review care plans for high-risk high cost ACO beneficiaries currently receiving post-acute care services.

This position requires a high frequency of contact with the very high risk ACO patient and their care givers for education of health promotion and self-care skills as well as facilitating compliance with the required quality measures for all ACO patients. This position requires advanced nursing knowledge and expertise to identify and implement improvement processes and the ability to direct and implement care coordination plans both in both in-patient and out-patient settings.

Qualifications

Job Duties/Responsibilities:

• Provides daily leadership and guidance to the LVN Nurse Navigator teams to ensure adherence to routine expectations by overseeing necessary training, accountability, and clinical oversight where necessary.
• Collaborates with healthcare providers both primary and post-acute, acute/sub-acute case management staff, and provider support staff to develop and review care plans for high-risk high cost ACO patients.
• Ability to earn and maintain trust of patients, patient representatives, physicians and health care providers.
• Provides guidance to the LVN Nurse Navigator team through advanced knowledge of disease management systems, wellness resources, and supportive services
• Timely documented communication and education with physician, patients and patient representatives regarding opportunities for modification of patient health risk factors.
• Leads and facilities case conferences to enhance communication and promote continuity of care.
• Works closely with the ACO staff as well as contracted vendors and support staff to facilitate timely transitions of care.
• Researches service resources in the community and elsewhere to meet patient needs consistent with plan benefits.
• Prepares accurate and timely required department reports related to team efficiency and ACO utilization

Requirements:

• Graduation from an accredited nursing education program.
• Licensed by the State of Texas to practice as a registered nurse.
• Advanced working experience in an ACO model alongside healthcare providers and case management.
• Minimum of five years of Case Management experience preferred.
• Recent (within past 3 years) working knowledge of Interqual criteria and Milliman Care Guidelines preferred.
• Minimum of three years in clinical medical/surgical nursing practice within a hospital setting. 
• Ability to effectively communicate in English, both verbally and in writing.
• Bilingual Spanish preferred.
• Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) Preferred
• Ability to document in different electronic health records as well as utilize Microsoft Products

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