Specialty Nurse Navigator - Lung Program - Bethesda North

This position provides comprehensive care coordination supporting a holistic and longitudinal approach across the continuum related to specific episodes of care.

This position assists with informed decision making, collaborating with a multidisciplinary team to allow for timely screening, intervention, and increased supportive care throughout the patient experience.

This position provides individual assistance to patients, families, and caregivers to help identify and overcome barriers which may hinder quality, medical, and psychosocial patient care.

Job Requirements

• Associate's Degree in Nursing
• Equivalent experience accepted in lieu of degree
• RN, Registered Nurse

Progressive nursing experience in hospital, ambulatory or home health Strong customer service and communication skills Ability to work with Physicians and others and collect data, generate reports, and provide analysis via computers and EMR 2-3 years experience Clinical Nursing Experience in the specialty area for which Navigator position is being hired (i. e.: orthopedics, cardiac, oncology, etc.)

2-3 years experience Clinical Nursing Experience in home care preferred

Job Responsibilities

Assess the patient's plan of care and develops, implements, monitors, and documents utilization of resources and progress of the patient through their care, facilitating options and services to meet the patient's healthcare needs.

Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes. Serves as a liaison for referring physicians and connections to community resources.

Assesses clients’/caregiver(s)’ activation, literacy level and self-management capabilities. Evaluate patient functional abilities and limitations. Determine if intervention is needed.

Assist the patient/family through diagnostic services, treatment and care and monitor clinical progress for defined episodes including transition to post-acute environment.

Communicates delays in care, functional status and changes in clinical status to specialist and primary care provider (PCP) and coordinates required follow-up and monitoring.

Educates client and family/caregiver(s) on diagnosis, course of care, medication, medication reconciliation and nutrition and moves client toward self-management. Collaborates with the patient and family when setting goals; initiate transition planning and recommends additions to or modification of referring orders.

Establish treatment goals that are functional, measurable and patient related. Establish and implement a patient centric plan of care that is aligned with clinical protocols in acute, ambulatory and post-acute environment to achieve treatment goals.

Reviews and analyzes model of care clinical pathway process improvement activities for appropriate populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes. Participates in ongoing staff development Establish and promote a collaborative relationship with Provide support for data collection and reporting, as needed, for value based contracts.

Other Job-Related Information

Working Conditions

• Climbing - Occasionally
• Concentrating - Frequently
• Continuous Learning - Frequently
• Hearing: Conversation - Consistently
• Hearing: Other Sounds - Consistently
• Interpersonal Communication - Consistently
• Kneeling - Rarely
• Lifting <10 Lbs - Occasionally
• Lifting 50+ Lbs - Rarely
• Lifting 11-50 Lbs - Rarely
• Pulling - Occasionally
• Pushing - Occasionally
• Reaching - Occasionally
• Reading - Frequently
• Sitting - Frequently
• Standing - Occasionally
• Stooping - Rarely
• Talking - Consistently
• Thinking/Reasoning - Frequently
• Use of Hands - Frequently
• Color Vision - Frequently
• Visual Acuity: Far - Occasionally
• Visual Acuity: Near - Consistently
• Walking - Occasionally

TriHealth SERVE Standards and ALWAYS Behaviors

At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and

Live the Following

Serve: ALWAYS…

• Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
• Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel: ALWAYS…
• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
• Offer patients and guests priority when waiting (lines, elevators)
• Work on improving quality, safety, and service

Respect: ALWAYS…

• Respect cultural and spiritual differences and honor individual preferences.
• Respect everyone’s opinion and contribution, regardless of title/role.
• Speak positively about my team members and other departments in front of patients and guests.

Value: ALWAYS…

• Value the time of others by striving to be on time, prepared and actively participating.
• Pick up trash, ensuring the physical environment is clean and safe.
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.

Engage: ALWAYS…

• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion with customers, team members and the community