Patient Navigator - Franciscan Alliance : Job Details

The Patient Navigator I identifies populations and patients at high risk for readmission and patients who are readmitted, with a focus on social determinants of health. Establishes goals with patient and families, provides one on one education and counseling while inpatients, coordinates along with care team specific focused discharge interventions and services, makes follow up contact to identify and remove barriers to clinical stabilization, and continuity of care. Partners with community providers to ensure continuity of care plan.

With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.

What You Can Expect

• Monday through Friday, day shift. No weekends or holidays
• Implements a team approach for the delivery of healthcare services to patients, effectively utilizing all available staff resources, to ensure a spirit of cooperation and stewardship.
• Communicates proposed discharge plan to patient caregivers and families and utilized post-acute care agencies.
• Identifies patients at high risk for readmission utilizing a risk stratification toll in EPIC, BPCI diagnosis, comorbidities, social determinants of health and ED utilization.
• Identifies readmitted patients through EPIC report.
• Meets with patients and families to complete readmission interview and identify a potential cause for the readmission, to assist in promoting healthy living with efforts to have the patient remain in the least restrictive environment while reducing the risk for multiple hospital admission.
• Promotes health coaching post discharge to patients promoting self-management and problem solving of identified needs.
• Completes root cause analysis on patients requiring readmission through patient interview and chart extraction, then identifies trends and patterns along with feedback for improvement.
• Assists the Emergency Department care management team with potential readmit patients.

Qualifications

• Required Bachelor's Degree Social Work
• 5 years Social Services Preferred

Travel Is Required: Never or Rarely

Equal Opportunity Employer

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.