Care Navigator - Population Health

Lehigh Valley Health Network • REMOTE IN PENNSYLVANIA, PA

2d • Remote

About The Position

The Care Navigator implements individualized care plans based on patients’ physical, mental, and social needs and medical or pre-surgical clinical assessments. The role supports smooth transitions and evidence-based disease management for select populations before hospitalization and/or for a period after discharge. Working within a multidisciplinary team, the Care Navigator provides patient and family education and helps patients navigate the continuum of care.

This position is remote in Pennsylvania, with a day shift schedule of Monday through Friday, 8:00 a.m. to 4:30 p.m. A weekend rotation is possible.

Requirements

• Bachelor’s degree in Nursing; experience in lieu of a bachelor’s degree may be considered.
• Five years of experience working as a registered nurse (RN).
• Two years of previous experience in case management, disease management, home health care, a hospital, or a physician office setting.
• Two years of prior electronic medical record (EMR) experience.
• Ability to set priorities to coordinate care plans efficiently.
• Ability to use effective strategies when interacting with people from diverse backgrounds.
• Ability to recognize how cultural, social, economic, and behavioral factors affect accessibility, availability, acceptability, and delivery of public health services.
• Knowledge of computer applications and analytical tools.
• RN - Licensed Registered Nurse, Pennsylvania, required upon hire.
• CACRN - Certified Ambulatory Care RN, Pennsylvania, required within 3 years; or CCCTM - Cert Care Coord-Transition Mgt MSNCB, Pennsylvania, required within 3 years.
• Ability to lift and carry 25 pounds; frequent sitting, standing, and keyboard use. Patient-care providers may need to kneel, bend, squat, and perform CPR.

Nice To Haves

• Master’s degree in Nursing.
• Two years of condition- or population-specific experience, such as Orthopedics, Cardiac, Pulmonary, GI, or Pediatrics.

Responsibilities

• Identify patients who are not meeting clinical goals or important quality metrics and arrange follow-up according to protocol, as appropriate.
• Review and update medication lists and accurately document known allergies in the electronic health record.
• Use registries, other data, and published evidence to assist point-of-care decision-making; support quality improvement, pilot participation, and other research activities.
• Identify actual or potential deviations from standards of care and system problems that could cause errors, delays, complications, or increased costs.
• Establish and maintain relationships with hospitals, rehabilitation facilities, and other post-acute care facilities.
• Provide care navigation services to specialty populations, including LVHN Specialty Institutes and BPCI-A.
• Collaborate with patients and families to establish mutual goals based on patient needs and problems.
• Identify healthcare-system, transportation, financial, and psychological barriers; collaborate to solve problems, coordinate services, and advocate for patients and families.
• Provide patient and family education and facilitate navigation across the continuum of care.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level