PRN RN Patient Navigator (Weekends)

About the role

The Patient RN Navigator provides specialized nursing services to individuals with health needs ranging from simple to complex, focusing on promoting optimum wellness and disease prevention. Services are provided under the supervision of the Director of Case Management, collaborating with state, local, public, and private agencies to ensure comprehensive care.

Responsibilities

• Aid patients and families in understanding their diagnosis, treatment options, and available resources, including educating eligible patients about strategies to improve quality of life and reduce hospital admissions.
• Facilitate post-hospital follow-up appointments and coordinate with various healthcare and community resources.
• Collaborate with other community agencies to resolve client’s health, psychosocial, or financial issues impacting their health care and hospitalizations.
• Coordinate multidisciplinary planning conferences, develop patient summaries, and document recommendations using standardized care protocols.
• Develop and implement patient education programs and tools.
• Monitor and evaluate high-risk patient populations, providing additional follow-up calls to ensure continuity of care.
• Assist patients with identifying and accessing necessary services, including education, health care, counseling, transportation, and medication.
• Assess clients dynamically, develop case management plans, and work with clients to achieve plan goals.
• Identify and prioritize at-risk community populations, utilizing advanced assessment skills to work autonomously with community agencies, hospitals, health care providers, and social service agencies.
• Act as a client advocate in securing necessary services and resources.
• Participate in interdisciplinary team meetings and lead or contribute to primary and secondary prevention initiatives.
• Adhere to productivity benchmarks and maintain a safe work environment.
• Perform outreach efforts to establish and maintain working relationships with key customers.

Requirements

• Graduate of a school of professional nursing.
• RN with two years of acute care hospital case management/patient navigation experience preferred.
• Previous experience with chronic conditions such as CHF, COPD, pneumonia, joint replacement, and new diabetic patients, and mitigating readmissions is preferred.
• Current licensure as a Registered Nurse in the state of Texas, or immediately eligible.
• Strong analytical, data management, organizational, and time management skills.
• Knowledge of teaching/learning theories and skills in developing and providing individual and group education/training.
• Knowledge of community resources and ability to assess clients with complex social, mental, and health problems.
• Skilled in creating interpersonal relationships, interacting with diverse populations, and maintaining confidentiality.