Navigator,Clinical Care Job Boston area,Massachusetts USA,Healthcare

Job Profile Summary

This role focuses on performing activities associated with evaluating, developing, recommending, implementing, and carrying out the policies and procedures related to the delivery of high quality patient care. In addition, this role focuses on performing the following Care Navigation related duties include:
Focuses on the patient's needs and helps guide the patient through the healthcare system and works to overcome obstacles that are in the way of the patient receiving the care and treatment they require. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a “hands on” environment.

The majority of time is spent in the delivery of support services or activities, typically under supervision. An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation.

Job

Overview

This position supports and facilitate transitions across the care continuum through telephonic patient outreach, coordination of care, referrals to providers and agencies. Acts as a liaison between providers and clinical resources to ensure the patient is actively involved in decision making for all aspects of care including post discharge follow up and goals toward preventing avoidable readmissions. Supports support multiple areas of the Clinical Care and Operations Team by creating and distributing multiple patient activity reports and other patient-based reports including databases for referrals, plan based level of care authorizations, and out of network activity including emergency and inpatient encounters.

Minimum Qualifications

High school diploma or GED.

Two (2) years of experience in a clinical setting (nursing unit, care management, physician’s office)

Preferred Qualifications

College Degree.

Medical Assistant (MA) certification.

Three (3) years of related experience.

Duties and Responsibilities

Creates and distributes daily patient activity reports to provider offices. Includes but may not be limited to Emergency Department, Urgent Care encounters and daily hospital discharges.

Reviews, authorizes, and assigns referral request submitted for review.

Provides hospital admission report review and production of review sheets for level of care review.

Tracks, documents, and plans level of care determinations.

Identifies authorization/denial/pending, level of care assigned and number of days to be paid.

Reviews and distributs walk around reports to provider offices.

Schedules and/or adhoc research and documentation as deemed appropriate by Clinical Operations and Programs Sr. Manager. Includes but not limited to National Plans, Leakage, Trauma, Out of Area, High cost cases.

Communicates to clinic offices, office managers via email and presentations at meetings included but not limited to the practice type based and large Primary Care Physicians and Specialty Care Physician meetings as needed.

Runs daily admission and discharge lists for resource team and skilled nursing facility nurse practitioner and prepares team list for appropriate follow-up for the day. Coordinates with hospital staff including continuity of care department on shared patients.

Monitors emergency department utilization at set intervals throughout the day and communicates information to assigned clinical staff for real-time intervention.

Conducts telephonic patient…

Navigator, Clinical Care