Job Ref: 22921
Talent Area: Professional
Houston Methodist Specialty Physician Group
Houston, TX 77030
Area/Department: Physician Alliance
Employment Type: Regular
Job Type: Full-Time
Organization: Houston Methodist
Work Shift: DAY
Work Week: M - F
Houston Methodist Specialty Physician Group - As one of the nation’s leading hospitals and academic medical centers Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.
The Care Navigator, RN provides care management across the continuum of care for patients, clients and employees to promote positive outcomes and population health, creating patient safety through all transitions, identifying opportunities for intervention and proactive solutions for the promotion of health as defined by the patient and or system. The registered nurse works with physicians, employers, families, and the community to provide quality transitions in care. The Care Navigator reports directly to the manager, while also receiving leadership from the Care Manager and Care Manager Lead.
System and department specific ICARE values
INTEGRITY: We are honest and ethical in all we say and do.
COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
ACCOUNTABILITY: We hold ourselves accountable for all our actions.
RESPECT: We treat every individual as a person of worth, dignity, and value.
EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
Duties and Responsibilities are cross-referenced to the hospital's Pillars of Excellence and will be transferred to the Performance Evaluation.
1. Using telephonic interaction as the mode of delivery, facilitates access to care by assessing needs, offering clinical options, and referring to health care providers
2. Actively manages assigned panel of patients
3. Elicits, assesses and prioritizes patient information and recommends most appropriate level of care using evidenced based protocols.
4. Serves as a clinical contact for hospital patients post discharge
5. Works collaboratively and maintains active communication with physicians, nurses, office staff and other members of the multidisciplinary care team to resolve problems that are identified during follow-up phone calls
6. Interacts with callers, physicians, other departments, and member of the community in a professional and respectful manner
7. Demonstrates respect for individual, cultural and social diversity. Maintains confidentiality of information.
1. Adhere to established productivity benchmarks.
1. Collaborates with all health care providers to optimize patient outcomes.
2. Proactively identifies and resolves delays and obstacles to services for the patient.
3. Facilitates communication with home health agencies, DME suppliers, pharmacies, and other community resources.
4. Maintain detailed records to measure effectiveness of program throughout the process
5. Review patient case lists generated by technology-enabled data triggers to identify patients/clients/employee that could benefit from intervention
6. Provides physician referrals to appropriate specialists
7. Meet patient and patient family needs; take responsibility for a patient's safety, satisfaction, and clinical outcomes; use appropriate interpersonal techniques to resolve difficult patient situations and regain patient confidence.
8. Participates in collaborative performance improvement activities
1. Able to work in a fast paced environment committed to providing immediate resolution to patient problems
2. Serves as a patient/client/employee advocate and assists in the identification and improvement of service delivery.
3. Schedule follow-up appointments for patients and provide information and reminders to patients & physicians¿ offices
4. Follow patients throughout the care continuum, including inpatient admissions, and collaborating with inpatient care management resources.
1. Develops processes in conjunction with HMH service line leadership in order to meet the needs of patients/clients/employees.
2. Exhibits a workable knowledge of the teaching principles of health care information to adult and geriatric populations.
3. Set measurable goals for yearly focal point review
4. Seek out HMH committees and events to participate in to develop networks within the HMH system.
This position description is not intended to be all inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required. The Houston Methodist Hospital reserves the right to revise or change job duties and responsibilities as the need arises.
3 years of clinical nursing, home health, and/or case management experience required. Experience in telehealth triage, emergency medicine, adult ambulatory care preferred.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Please list below the required and optional Licenses, Certifications and Registrations. If multiple licenses/certs/registrations are available specify the preferred license/cert for the job.
Required Licenses: Valid RN license in state of Texas
Optional Certificates: Case Management (CCM, ACM, RN-BC CM), Certified Diabetes Educator (CDE)
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.
VEVRAA Federal Contractor – priority referral Protected Veterans requested.