Health at Home Navigator, RN

CommonSpirit Health at Home•Sugar Land, TX

3d•$37 - $56•Onsite

About The Position

The Health at Home Navigator - RN role will be based out of the St. Luke's Health - Sugar Land Hospital - Sugar Land, TX. This is an exciting hospital-based role for Deaconess Home Health, ideal for driven professionals passionate about creating solutions and thriving in a startup environment. As a Navigator, you will be part of the hospital team of discharge planners with the sole focus of driving care to the home setting. The Health at Home Navigator (HHN) uses expertise in home-based services to ensure continuity of care for patients transitioning from acute care to home. By collaborating with physicians, case managers, and hospital teams, you play a critical role in improving clinical outcomes, patient satisfaction, and the overall care experience.

Requirements

MUST BE A Licensed RN in the State of practice
A strong background in home health and hospice services is required.
Completion of an accredited registered nursing program.
Current unrestricted license as a registered nurse in state(s) of practice.
Home Health experience or prior navigator experience in a post-acute setting such as ALF/SNF/ILF.
Excel in communication and patient education
The courage to step into a startup type environment and make a lasting difference

Nice To Haves

Combination of Acute and Post-Acute care delivery experience preferred.
A desire to shape and lead an innovative program

Responsibilities

Collaborate with providers, case managers, and social workers to facilitate seamless and timely discharges to home-based services, prioritizing patient-centered care.
Assist patients and families in navigating post-acute care options, addressing barriers, and advocating for home-based services that align with their needs.
Identify opportunities to reduce financial and clinical risks, ensuring patients and families are supported during and after their hospital stay.
Actively participate in multidisciplinary rounds, serving as a patient advocate to ensure efficient and effective continuity of care.
Initiate discussions about care destinations and discharge planning upon patient admission, conducting informational visits to promote home health as a preferred option.
Work with hospital partners to identify and prioritize patient populations who will benefit most from home-based services, such as home health or hospice.
Address and navigate barriers within the healthcare system to ensure patients have access to appropriate home-based care.