RN - NURSE NAVIGATOR - ACO - TEMP

Responsibilities

Job Summary:  The ACO Nurse Navigator is a registered nurse who functions as a liaison 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 assesses needs and coordinates resources within and outside the ACO (as approved by the ACO Director) to promote optimal health benefits and outcomes (both clinical and financial).  The ACO Nurse Navigator will provide onsite review at the local UHS Acute facility, and establish rapport with local hospital case management, hospitalist, ER case management, and discharge planning staffs to expedite timely transitions of care and discharge of ACO patients. 

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.  A Patient Navigator will also ensure the coordination and communication of a patient’s treatment plan and general status to all care givers during all transitions of care.  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

Regulatory Requirements:

·                    Graduation from an accredited nursing education program.

·                    Licensed by the State of Texas to practice as a registered nurse.

·                    Minimum of three years of Utilization Review/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.

Language Skills:

·                    Ability to effectively communicate in English, both verbally and in writing.

Skills:

·                    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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