Nurse Navigator Family Planning Clinic

Description Job Title: Nurse Navigator - Family Planning Clinic Location: St. Mary's OBGYN - 65 Genesee St Ste 3, Rochester, NY 14611 Hours Per Week: 40 Schedule: Monday-Friday 8am-4pm SUMMARY Provides proactive case coordination/patient navigation for patients, including triage management, algorithm management, utilization management and resource management. Organizes services across the continuum from pre-registration through discharge from the Center to affect optimal patient outcomes, achieve continuity and quality of care, reduces cost and provide customer satisfaction. Provides assistance to patients and families through evaluation of social, emotional and financial needs and coordinates and facilitates appropriate resources. Communicates with third party payors, follows Health System policies and procedures, and assist with continually improving the quality and effectiveness of case management/patient navigation. RESPONSIBILITIES Reviews the medical record with referring provider as soon as possible after admission-within the first 12 to 24 hours. Applies utilization review criteria to assess and document appropriateness of admission, continued stay and level of care. Interviews patients and/or family members to obtain information about social, emotional, and financial factors which impact health status. Assesses needs for progress along department algorithm of care and continuing care or resource support following discharge. Responds to referrals from patients, families, physicians, hospital staff, and community agencies. Collaborates with patient/family and members of health care team to develop appropriate post-hospital plans for continuing care or resource support following discharge. Utilize all appropriate medical, social, and financial resources available to support the patient/family and to ensure smooth transition to appropriate levels of care. Responds to referrals from patients, families, physicians, hospital staff, and community agencies. Collaborates with patient/family and members of health care team to develop appropriate post-hospital plans for continuing care, to initiate referrals. Proactively identifies problems with utilization of resources and assures specific tests, consults etc. are done in a timely manner. Feedback is obtained and documented in the patient chart. Forward patient chart to physician for review when problems are identified. Intercedes with appropriate department or attending physician to identify cause. Communicates as needed with Physician Advisor, assures patient is placed on clinical pathway and monitors variances from pathway as appropriate. Maintains current information on community resources, third party payors, and managed care environment. Knowledgeable of changing rules/regulations, and policies/procedures. Maintains established departmental policies and procedures, objectives, quality management plan, environmental and infection control standards. Maintains appropriate and timely documentation through medical record entries, daily logs, computer entries, and monthly statistics. Prepares and maintains required documentation on each patient. Completes worksheets, communicates in a timely manner with physicians and coders, provides necessary statistics for data collection, and identifies case mix issues. May provide consultation and education to medical and hospital staff of inpatient and outpatient programs regarding role of case management. This may include appropriate management of resources, discharge planning and complex medical/legal issues. Assists in development of new services or policies appropriate to patient needs and consistent with strategic plan Makes referrals to administrative director, medical director, quality management, risk management, infection control, and hospital departments when potential quality problems are identified. Refers to and consults with clinical social worker on patients with complex psychosocial/financial needs. Develops and maintains