Position Summary

The Clinical Navigator participates in a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs. On an aggregate level, the Clinical Navigator will track performance, identify opportunities to streamline care practice, and collect/report relevant data. Must be flexible and adapt to changes in the work environment; manage competing demands; change the approach or method to best fit unique situations; be able to cope with delay or unexpected events. Take responsibility; keep commitments; and complete tasks on time. Volunteer readily; take independent actions; ask for and offer help when needed.

Minimum Requirements

Education

• RN/BSN or MSW/LMSW

Experience

• Five years of experience in outpatient setting, population health, social services, home health, or other health care setting. Program management experience in a clinical setting.

License/Registration/Certifications

• Valid drivers license, RN or LMSW

Preferred Requirements

Preferred Education

• N/A

Preferred Experience

• Team Lead experience

Preferred License/Registration/Certifications

• N/A

Core Job Responsibilities

• Actively manage high-risk members including members with complex medical and/or psychosocial problems through care coordination including closing care gaps, scheduling members for recommended follow-up, retrieving missing documentation, condition education, and participating in Multidisciplinary team meetings.
• Identify opportunities for intervention for each member.
• Coordinate and collaborate with the team members on moderate/high risk members.
• Develop a personalized care plan including self-management goals with each member, sharing each member’s self-management goals with the member’s care team including the member’s physician.
• Ensure the proper handling and documenting of patient records to ensure compliance with patient health information applicable to the preservation, accuracy, and completeness of communication and/or retention of patient information, meeting all HIPAA regulations.
• Provide telephonic or face-to-face outreach to engage members to assess their readiness to change by using motivational interviewing techniques to help members identify and overcome barriers that often include behavioral risk factors, such as smoking, poor health literacy, and poor disease management.
• Proactively collaborate with providers, community resources, and other colleagues to help members achieve the best possible outcomes.
• Must meet productivity standards set for by direct supervisor.
• Serve as a back-up to other Clinical Navigators as needed.
• Provide clinical support, expertise, and training, to other clinical staff as needed.
• Meet with physician providers as needed to discuss quality, outcomes, and follow-up care.
• Participate in site specific Multidisciplinary Planning Conferences (MPC’s) as needed.
• Contributes to team effort by accomplishing results as needed.
• Properly documents all communication in accordance with policies and procedures.

• May perform other duties as assigned.
• While performing the duties of this position, the employee is regularly required to talk or hear.
• The employee frequently is required to use hands or finger, handle, or feel objects, tools or controls.
• The employee is occasionally required to stand, walk, sit, reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl.
• The employee may have exposure to load noise.
• Must be able to sit for an extended period of time.
• Must be able to walk/stand for extended period of time.
• The employee must occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus.