Evanston Hospital
Patient Care Navigator MSW- Chronic and Complex Care Management Program - Days
Evanston Hospital, Skokie, Illinois, United States, 60077
Patient Care Navigator Msw- Chronic And Complex Care Management Program
Hourly Pay Range: $32.60 - $48.90 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors. Position Highlights: Position: Patient Care Navigator Msw- Chronic And Complex Care Management Program Location: 4901 Searle Parkway, Skokie (Corporate Office) Full Time: 40 hours/week Hours: Monday
Friday (8:30 am - 5:00 pm), 2 days onsite required and 3 days remote optional. Weekend and holiday required per rotation. Remote optional for weekend and holiday coverage. A Brief Overview: The SW Care Navigator is responsible for the case management and care coordination of their population of high-risk patients. This position will collaborate with the RN Transitional Care Navigator. This position involves helping patients understand their diagnosis, treatment options, and ensure that they are connected with the optimal resources across the continuum of care. The SW Care Navigator will help to identify and address complex family dynamics and other social determinants of health. This role will coordinate care by facilitating smooth transitions of care while ensuring quality cost-effective patient outcomes. Serves as a liaison between their patient population and all other providers. Will be responsible for key metrics of success, which include improving the overall cost of care, length of stay optimization, reduction in excess days, reduction in SNF utilization and improvement in SNF care transitions, reduction in 30-day readmission rate and ED utilization. What You Will Do: Guides patient and family through the health system from diagnosis, testing, treatment and follow-up care to assist patients with navigating the continuum of care. Eliminates barriers to patient's access to health care services and facilitates continuity of care/care coordination. Partners with the healthcare team to ensure clinical decision-making, implementation of recommendations, and care plans are timely and appropriate. Routinely assesses and monitors the patient's status, needs, and progress by proactively reaching out to the patient/caregiver and ensuring that they are connected to the most appropriate and impactful resources. Acts as advisor/educator by providing emotional support including goals of care and counseling. Provides and/or arranges clinical education including medication management, community resources, financial resources, and expert guidance to patients and families to promote their ability to understand and meaningfully participate in the healthcare process and personal decision-making. Responsible for outreach efforts to establish and maintain positive working relationships with patients, family including multidisciplinary team i.e. physicians, office staff, diagnostic staff, nurses, social services staff, home services etc. Facilitates appointments for appropriate consultations and support services within established protocols. May need to travel to visit the patient at home. Connects with providers across the care continuum proactively and in a timely way. Participates as part of a call coverage structure. Ensures that patients have and keep post-discharge follow-up appointments and that their medications are accurate and appropriately reconciled at each point of care. Helps patients understand their insurance coverage as well as the post-acute level of care, necessary durable medical equipment required for recovery. Develops concise patient care plan for use by the patient and the care team, and documents all communication with the patient so it is visible across the care team. Develops, plans and presents patient education programs and tools and enrolls patients in these programs so they are able to benefit maximally from all of the program elements. Subject Matter Expert - Model behaviors and organizational standard to promote quality, patient safety, and enhanced patient care coordination. Knowledge of Medicare, Medicaid, and Third-party reimbursement (i.e. HMO and Health Plan Benefits). Teamwork - Actively participates in performance improvement and other approaches. Collaborate with the team members to develop effective work processes that may lead to improvement of work. Has a good understanding of the goals and expectations so to develop work functions across the team is aligned and synergistic. Risk Management
Uses insights from risk management and patient advocacy to understand opportunities to improve day to day operations of care coordination. Other Duties
As this job evolves, this role will complete others duties assigned. What You Will Need: Education: Masters Degree in Social Work Required Certification: LSW Required. LCSW strongly preferred. Clinical certification, such as case management certification, is beneficial. Experience: 2+ years of related health care experience required. Preferred 5 years of related healthcare experience. Discharge planning, case management, home services, ambulatory services working with high-risk patients beneficial. Experience with behavioral health also beneficial. Unique or Preferred Skills:
Able to communicate and work collaboratively with a range of stakeholders and team members Knowledge of community resources Experience with Microsoft Office Suite Strong interpersonal and oral communication skills Strong computer and data entry skills Experience with Electronic Medical Record (EMR) platform preferred Proven leadership skills Ability to work independently, setting priorities to coordinate care plan efficiently
Benefits: Premium pay for eligible employees Career Pathways to Promote Professional Growth and Development Various Medical, Dental, Pet and Vision options Tuition Reimbursement Free Parking Wellness Program Savings Plan Health Savings Account Options Retirement Options with Company Match Paid Time Off and Holiday Pay Community Involvement Opportunities
Hourly Pay Range: $32.60 - $48.90 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors. Position Highlights: Position: Patient Care Navigator Msw- Chronic And Complex Care Management Program Location: 4901 Searle Parkway, Skokie (Corporate Office) Full Time: 40 hours/week Hours: Monday
Friday (8:30 am - 5:00 pm), 2 days onsite required and 3 days remote optional. Weekend and holiday required per rotation. Remote optional for weekend and holiday coverage. A Brief Overview: The SW Care Navigator is responsible for the case management and care coordination of their population of high-risk patients. This position will collaborate with the RN Transitional Care Navigator. This position involves helping patients understand their diagnosis, treatment options, and ensure that they are connected with the optimal resources across the continuum of care. The SW Care Navigator will help to identify and address complex family dynamics and other social determinants of health. This role will coordinate care by facilitating smooth transitions of care while ensuring quality cost-effective patient outcomes. Serves as a liaison between their patient population and all other providers. Will be responsible for key metrics of success, which include improving the overall cost of care, length of stay optimization, reduction in excess days, reduction in SNF utilization and improvement in SNF care transitions, reduction in 30-day readmission rate and ED utilization. What You Will Do: Guides patient and family through the health system from diagnosis, testing, treatment and follow-up care to assist patients with navigating the continuum of care. Eliminates barriers to patient's access to health care services and facilitates continuity of care/care coordination. Partners with the healthcare team to ensure clinical decision-making, implementation of recommendations, and care plans are timely and appropriate. Routinely assesses and monitors the patient's status, needs, and progress by proactively reaching out to the patient/caregiver and ensuring that they are connected to the most appropriate and impactful resources. Acts as advisor/educator by providing emotional support including goals of care and counseling. Provides and/or arranges clinical education including medication management, community resources, financial resources, and expert guidance to patients and families to promote their ability to understand and meaningfully participate in the healthcare process and personal decision-making. Responsible for outreach efforts to establish and maintain positive working relationships with patients, family including multidisciplinary team i.e. physicians, office staff, diagnostic staff, nurses, social services staff, home services etc. Facilitates appointments for appropriate consultations and support services within established protocols. May need to travel to visit the patient at home. Connects with providers across the care continuum proactively and in a timely way. Participates as part of a call coverage structure. Ensures that patients have and keep post-discharge follow-up appointments and that their medications are accurate and appropriately reconciled at each point of care. Helps patients understand their insurance coverage as well as the post-acute level of care, necessary durable medical equipment required for recovery. Develops concise patient care plan for use by the patient and the care team, and documents all communication with the patient so it is visible across the care team. Develops, plans and presents patient education programs and tools and enrolls patients in these programs so they are able to benefit maximally from all of the program elements. Subject Matter Expert - Model behaviors and organizational standard to promote quality, patient safety, and enhanced patient care coordination. Knowledge of Medicare, Medicaid, and Third-party reimbursement (i.e. HMO and Health Plan Benefits). Teamwork - Actively participates in performance improvement and other approaches. Collaborate with the team members to develop effective work processes that may lead to improvement of work. Has a good understanding of the goals and expectations so to develop work functions across the team is aligned and synergistic. Risk Management
Uses insights from risk management and patient advocacy to understand opportunities to improve day to day operations of care coordination. Other Duties
As this job evolves, this role will complete others duties assigned. What You Will Need: Education: Masters Degree in Social Work Required Certification: LSW Required. LCSW strongly preferred. Clinical certification, such as case management certification, is beneficial. Experience: 2+ years of related health care experience required. Preferred 5 years of related healthcare experience. Discharge planning, case management, home services, ambulatory services working with high-risk patients beneficial. Experience with behavioral health also beneficial. Unique or Preferred Skills:
Able to communicate and work collaboratively with a range of stakeholders and team members Knowledge of community resources Experience with Microsoft Office Suite Strong interpersonal and oral communication skills Strong computer and data entry skills Experience with Electronic Medical Record (EMR) platform preferred Proven leadership skills Ability to work independently, setting priorities to coordinate care plan efficiently
Benefits: Premium pay for eligible employees Career Pathways to Promote Professional Growth and Development Various Medical, Dental, Pet and Vision options Tuition Reimbursement Free Parking Wellness Program Savings Plan Health Savings Account Options Retirement Options with Company Match Paid Time Off and Holiday Pay Community Involvement Opportunities