Care Navigation Partner - Physician Practices

Lehigh Valley Health Network•Allentown, PA

5d•Onsite

About The Position

Imagine a career at one of the nation's most advanced health networks. Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work. LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day. Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Requirements

Bachelor’s Degree in nursing
3 years clinical experience in an inpatient or ambulatory setting
American Heart Association Basic Life Support - State of Pennsylvania
RN - Licensed Registered Nurse_PA - State of Pennsylvania Upon Hire

Nice To Haves

Master’s Degree in nursing

Responsibilities

Deliver education, outreach, and in-person assistance to patients served.
Collaborate with stakeholders to triage and process telephone calls from patients, caregivers, and providers ranging from general information to more complex situations related to care management.
Conduct one-to-one extended patient meetings.
Perform follow-up with patients, family/caregivers, providers, and community resources via e-mail, phone, or other communications.
Promote timely access to appropriate care.
Work to reduce emergency room utilization and hospital readmissions.
Create and promote adherence to care plan developed in coordination with the patient, primary care provider, and family/caregivers.
Support practice quality work and gap closure efforts.
Focus on chronic illness management as directed by care pathways and adjust plan of care as necessary to reduce emergency room utilization and hospital readmissions by leveraging data analytics and population risk reports to prioritize and tactically respond.
Build strong relationships to achieve patient goals and provide seamless care.
In partnership with patient and care team, develop and re-assess patient goals.
Maintain contact with patient and relevant circle of support from initial connection as required/needed to promote best health outcomes.
Plan and facilitate patient education and ensure patients and family comprehension of care and interventions.
Support practice quality efforts focusing on completion of health maintenance opportunities for managed population and assist practice with management of not met reports and portal outreach campaigns.
Complete pre-visit planning.
Assist patients with applying for community resources, including emergency financial assistance, housing assistance, access to foodbanks, and other community-based resources.