RN Care Navigator - South Pulmonary Clinic

INTEGRIS Health•Oklahoma City, OK

1d•Onsite

About The Position

Join our team as a day shift, full time, RN Care Navigator, at INTEGRIS Health Medical Group South Pulmonary Clinic in Oklahoma City, OK. Get to Know Your Team: INTEGRIS Health, Oklahoma’s largest not-for-profit health system, is seeking a dedicated caregiver to join us in our mission to partner with people to live healthier lives. Benefits of being an INTEGRIS Health caregiver include front-loaded PTO, medical benefits through the extensive INTEGRIS Health network, financial assistance for continued education, 24/7 mental health support and more. Take the first step toward growing your career by joining us.

Requirements

Current licensure as a Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state
Bachelors degree in nursing
Minimum of 4 years recent clinical experience in a variety of clinical settings
Excellent interpersonal communication and collaboration skills.
Computer experience required.
This job requires the incumbents to operate a INTEGRIS-owned vehicle OR personal vehicle (non INTEGRIS-owned) and therefore must have a current Oklahoma State Drivers License as well as a driving record which is acceptable to our insurance carrier

Nice To Haves

Case management experience preferred
Windows and Excel preferred

Responsibilities

Follows patients during their hospital stay and continue following post discharge facilitating self-management to avoid a preventable return to the hospital.
Works closely with multidisciplinary team to develop and implement the patient?s plan of care.
Ensures patients discharged from the hospital have a follow-up appointment with his/her provider and review any unmet needs prior to appointment.
Conducts a full assessment including but not limited to the support system and home environment.
Oversees hand-off of patients to post-acute facility, agency and principle acute provider and maintains contact (either by phone or in person) and provides interventions as needed.
Plans and conducts post discharge follow-up phone calls with patients and or caregivers to monitor patient progress, provide education and assist in making informed decisions regarding self-care.
Provides education, tools and training that align with the patient needs and willingness to learn to help patients and caregivers make informed decisions regarding self-care.
Utilizes motivational interviewing techniques and other member engagement techniques to facilitate patient?s adoption and adherence of care plans.
Ensures open communication with providers, patients, and caregivers to coordinate services within the organization, at outside facilities, at home and physician offices in the community to promote care and maximize care coordination and patient satisfaction.