Joint Care Navigator

Reid Health

11d•Onsite

About The Position

The Joint Care Navigator ensures that patients are pre-operatively assessed to establish a preliminary acute discharge plan, coordinates post-operative care across the continuum to assure key outcomes are achieved, and provides education to patients, significant others and to the community. This position must ensure that patients are prepared and cleared for surgery, with the necessary diagnostic results and other relevant paperwork at least 7-14 days prior to surgery. This position works collaboratively with Reid Peri-Operative Clinic, home health, physicians, case management, discharge planners, nursing, and rehabilitation to achieve desired patient outcomes through cost-effective use of healthcare resources. The Joint Care Navigator assists in tracking, monitoring, and improving post-operative outcomes such as postoperative complications, satisfaction, and cost-effectiveness using reporting features.

Requirements

Graduation from accredited nursing program (LPN) or Successful completion of a Medical Assisting course, Registered Medical Assistant or Certified Medical Assistant
At least 3 years clinical experience with orthopedic patients.
Indiana Nursing License, Registered Medical Assistant or Certified Medical Assistant.
Must maintain competence in BLS after initial training

Responsibilities

Assesses the care transition needs of the patient.
Develop patient centered goals with the patient and support system.
Collaborates with Interdisciplinary Team in development of the transition plan of care.
Performs pre-operative total joint classes and provide appropriate education.
Educates patient and their potential caregivers regarding the surgery and recovery process.
Utilizes effective teaching methods and approaches tailored to the individual patient needs.
Ensures patients complete all preoperative and post-operative questions including but not limited to HOOS/KOOS, PROMIS, Health Literacy, other joint pain and back pain surveys to ensure quality indicators are met.
Serves as a Liaison with PCP to ensure patient is seen timely by PCP for any postoperative medical concern not related to the surgery to avoid potential ER visit.
Provides community education regarding arthritis, related orthopedic conditions, and total joint replacement surgery.
Identifies opportunities for improving educational materials and processes.
Assists with coordinating post-hospitalization services.
Accompanies patients to peri-op visits as needed.
Fosters an environment of individual responsibility.
Re-enforces with patients the physician prescribed treatment and post-operative plan.
Provide community resources as needed.
Promotes self in a positive and professional manner.
Maintains patient and staff confidentiality.
Responsive to patient complaints by resolving issues while maximizing patient and surgeon satisfaction.
Establishes effective working relationships with surgeons.
Establishes effective working relationships with nursing, case management and rehab.
Obtains targeted data for performance improvement projects.
Collects and tracks performance improvement data.
Collects and presents patient reported outcomes to surgeons on a routine basis.
Assists with clinical effectiveness studies and projects.