Transition of Care Navigator-Outpatient - Summit Medical Group

Responsibilities

• Provides support to the Care Coordination Team.
• Analyzes and collects ADT (Admission-Discharge-Transfer) data.
• Sets up patients discharged from hospital to appropriate team members.
• Tracks patient discharge status and assignments to team members.
• Documents notifications of inpatient admission and other clinical correspondence in EMR.
• Facilitates sharing of medical information across the continuum of care.
• Collaborates with Home Health agencies to ensure collaboration of care between SMG and the agency.
• Secures patient records from healthcare facilities.
• Conducts chart reviews, educates patients, and facilitates follow-up with providers to promote completion of age-appropriate preventive care procedures.
• Maintains security and privacy of patients by keeping patient care information confidential.
• Participates in required training and attends team, departmental, and organizational meetings.
• Maintains quality of services provided to patients/caregivers through ongoing participation in team and departmental quality improvement activities.
• Updates job knowledge by participating in educational opportunities that support the advancement of Care Coordination including care transitions.
• Participates in the orientation and training of new staff as needed.
• Maintains strictest confidentiality both internally and externally.
• Adheres to expectations of the established corporate compliance plan.
• Participates in site-level Quality Improvement Activities.

Qualifications

• High School diploma or equivalent required.
• CMA or CNA preferred.
• Minimum 1 year of experience in clinical experience with preference for those that have worked in a Primary Care setting.
• Strong technical skills in Microsoft Excel and excellent ability to maintain databases as well as extract and analyze data from primary and secondary sources considered as a plus.