Care Navigator-Care Management Bklyn Hts, rotating weekends/holidays

The MetroHealth System   Cleveland, OH   Full-time
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The MetroHealth System, Cuyahoga County’s public health system, and its staff of nearly 8,000 provides care at MetroHealth’s four hospitals, four emergency departments and more than 20 health centers and 40 additional sites throughout Cuyahoga County. The health system is home to Cuyahoga County’s most experienced Level I Adult Trauma Center, verified since 1992, and Ohio’s only adult and pediatric trauma and burn center.  As an academic medical center, MetroHealth is committed to teaching and research. Each active staff physician holds a faculty appointment at Case Western Reserve University School of Medicine. Our main campus hospital houses a Cleveland Metropolitan School District high school of science and health. The MetroHealth System is committed to creating a healthier community.

 

 

Summary: 


Assists the Care Coordinator and the interdisciplinary medical home care team in the provision of care navigation activities. Works with selected patients as assigned. Assists the Care Coordinator with access and utilization management, proactive patient panel management, care facilitation, and treatment planning functions. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.

 

 

Responsibilities:


1. Assists the Care Coordinator in coordinating the care of patients based on medical or psychosocial risk by:

a. Scheduling appointments with primary care services.

b. Requesting appointments with specialty services on a patients’ behalf.

c. Arranging transportation or other necessary patient services.

d. Aiding the Care Coordinator with implementing changes to patient care plans as needed.


2. Assists the Care Coordinator in performing activities both at the point of service and through targeted, including, but not limited to:

a. Reviewing the patient’s utilization/access data, appointment history, and patient care plan compliance.

b. Assists the Care Coordinator with the care of other patients referred by medical providers.


3. Assists the Care Coordinator and the interdisciplinary medical home care team in the formulation of care plans for selected patients based on high medical or psychosocial risk.


4. Maintains current documentation of activities in Epic to promote the well-coordinated/seamless delivery of care to patients.


5. Contributes to providing chronic disease self-management support to patients, including helping them acquire the information, skills, and motivation necessary to successfully manage their conditions.


6. Assists the Care Coordinator in providing patient educational support, assistance, and referral services when indicated.


7. Works under the Care Coordinator’s supervision to identify barriers to plan of care adherence and strategies to overcome barriers for assigned patients (i.e. transportation, prescription coverage, financial issues, housing needs, employment issues, and entitlement services).


8. Assists the Care Coordinator with monitoring, ensuring compliance with, and modifying care plans as needed.


9. Assists with providing proactive activities related to disease management for identified patient populations within the practice patient panel, including:

a. Monitoring specified clinical and utilization activities.

b. Assisting with targeted patient outreach.

c. Following-up on these activities (i.e. with the diabetic, heart failure, or hypertension populations).


10. Contributes to addressing home care needs by visiting the patient’s home, interviewing residents of the home, assessing the home for safety, and other risk issues; assists the Care Coordinator in documenting and communicating home care assessments.


11. Assists the Care Coordinator in coordinating the use of clinical and ancillary resources within and outside of the MetroHealth System to support access to services and achieving treatment goals stated in patient care plans.


12. Understands payment responsibilities based on the patient’s financial status, and assists with referrals to programs for financial assistance when needed.


13. Keeps current with trends, developments, and practices in the field as they relate to this work assignment; maintains current knowledge of the standards of care guidelines for chronic conditions impacting assigned patient populations.


14. Incorporates principles of teamwork in the resolution, completion, and follow-up of responsibilities.


15. Performs other job-related duties as assigned.

 

 

Qualifications:

:
Required:
HS Diploma or passage of a high school equivalency exam.
6 months of patient care experience.
Able to perform data entry.
Able to use computerized word processing software.
Familiarity with spreadsheets, data bases, and patient registries.
Knowledge of basic medical procedures and medical terminology.
Solid written, verbal, and interpersonal communication skills
Able to collaborate with the health care team and diverse patient populations.
Good judgment, flexibility, initiative, critical thinking skills, and problem solving skills.
Able to prioritize and organize tasks with attention to detail.
Reliable transportation to make home visits to patients as needed.
Possess a valid driver’s license for the State of Ohio.

Preferred:
Graduate of an accredited Medical Assistant program, AND completion of a school-sponsored externship.
Graduate of a Licensed Practical Nursing program.
Registered in good standing as a State Tested Nursing Assistant (STNA) with the Ohio Department of Health Nurse Aide Registry.
Fluency in writing, speaking, and interpreting both English and another designated foreign language.
Knowledge of Epic electronic health record system.

Physical Requirements:
May sit, stand, stoop, bend, and ambulate intermittently during the day.
May need to sit or stand for extended periods.
See in the normal visual range with or without correction.
Hear in the normal audio range with or without correction.
Finger dexterity to operate office equipment required.
May need to lift up to twenty-five (25) pounds on occasion.
Ability to communicate in face-to-face, phone, email, and other communications.
Ability to see computer monitor and departmental documents.


IND####


This job is no longer available.

The MetroHealth System

Cleveland, OH