Job detail

Nurse Navigator

Bienville Orthopaedic Specialists

#Data Entry #Care Plans #Skilled Nursing #HIPAA #Physical Therapy #Discharge Planning #DME #Continuum of Care #Home Care

Quick overview

This role involves managing a cohort of patients through a ninety-day episode of care, primarily within bundled payment programs, which includes completing necessary risk and clinical assessments. The Nurse Navigator is responsible for developing and implementing collaborative care plans across the entire continuum of care, coordinating with various providers and monitoring patient needs for services like home health and physical therapy.

Requirements summary

Candidates must be licensed to practice Nursing in Mississippi, with an RN preferred or an LPN with 10 years of experience, requiring 2-3 years of general nursing experience, preferably in orthopedics or discharge planning. Essential requirements include exceptional customer service and communication skills, proficiency in electronic records, strong data entry, the ability to work accurately in a fast-paced environment, and flexibility to travel and work overtime.

professional certificateInterpersonal SkillsCustomer ServiceTime ManagementDocumentationCommunication SkillsProblem SolvingCare Plan DevelopmentHIPAA ComplianceData AnalysisPatient EducationRisk AssessmentData EntryCare CoordinationInterdisciplinary CollaborationPatient ManagementTelephonic Follow Up

Job description

Essential Job Duties

Responsible for managing a group of patients throughout a ninety-day episode of care, as part of the Bundled Payment for Care Improvement (BPCI) Advanced program, Blue Cross Blue Shield Bundled patient and any other bundled programs.
Completion of preoperative risk assessment and post op clinical care assessments.
Educate the patient and caregiver of the process and expectations of the health care delivery system throughout the continuum of care, including pre-operative, acute stay, Inpatient Rehab (if applicable), Skilled Nursing (if applicable), Long Term Acute Care (if applicable), Home Care (if applicable) and access to community resources (if necessary).
Development and implementation of collaborative care plans throughout the continuum of care, specific to patient individual needs.
Collaborate with physician and monitor all providers in the pre-operative, acute, post-acute and outpatient settings, to identify patient needs such as: home health care, DME, physical therapy and community services.
Provide telephonic and/or onsite follow up with patients at planned intervals and as needed based on patient status.
Complete and submit all required documentation within established guidelines.
Input & maintain all files & documentation within care management system & practice medical record as appropriate.
Ongoing evaluation and revision of plan of care as determined by patient's health status. Communicate changes to all providers and multi-disciplinary care team members involved in the patient's care.
Identify gaps or barriers in the treatment plan and provide appropriate resources and services. Update care plan as needed throughout the continuum of care.
Understand the BPCI and other Bundle programs design, implementation, management, monitoring and reporting requirements.
Remain flexible and responsive when changes occur in patient activity and workload.
Maintain patient confidentiality and HIPAA compliance.
Perform other duties as assigned.

Education

RN Preferred
LPN with 10 years of experience
Education and experience considered for negotiation

Nurse Navigator

Quick overview

Requirements summary

Job description

Essential Job Duties

Education

Other Requirements

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