Medical Home Nurse Navigator | Full Time | Days

Concord Hospital • Concord, NH

6d

About The Position

Under the general supervision of the Director, Medical Home Navigation Program, the Medical Home Nurse Care Manager (NCM) facilitates coordination of care and communication, supporting patients with complex medical, behavioral and/or social issues who struggle with chronic care management and coordination needs. Coordination of care is patient centered and designed to include all providers and locations of health care to maximize patient wellness and cost effectiveness of care. Education Graduate from an accredited Nursing program, BSN required.

Requirements

• Licensure required: New Hampshire Board of Nursing license.
• Valid NH driver's license, insurance and driving record from Department of Motor Vehicles that meets organization and departmental standards.
• Minimum 3 years nursing experience
• Effective interpersonal, organizational and motivational skills required with ability to function as a team player, and proficiency in written and verbal communication.

Nice To Haves

• additional case management/care coordination experience preferred.

Responsibilities

• Identifies and enrolls eligible patients in the Medical Home Navigation service.
• Assesses the health status of enrolled patients.
• Develops and implements patient-centered care plans for accessing and coordinating needed care across the continuum.
• Serves as the contact for team-based communication about patients on the case load.
• Provides hospital discharge follow up for all patients in the case load.
• Provides education to patients in response to identified patient needs.
• Bases nurse care management actions by applying principles of purposeful, organized thinking to make sound clinical judgment/decisions.
• Documents measurement and evaluation of financial, clinical, functional and satisfaction outcomes as patient progresses towards desired goals.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1-10 employees