Description:As a Nurse Navigator at Dycora, you will ensure that our patients get the care they need and that we have the necessary resources to provide it. Your hard work and meaningful efforts will help us to continue providing the highest quality healthcare possible. You will have direct impact on the quality of care that our patients receive and will do what it takes to provide the highest quality care. Your outcome-focused work will leave you feeling empowered at the end of each day because you'll know you've made a difference in the lives of our patients.
We are seeking qualified candidates who have experience in this field and are ready to go to any length to get our patients and facilities the support they need. That's because you believe in our mission here at Dycora. Ideal Nurse Navigator candidates should also have:
- Communicate, negotiate, and act as a liaison between center or agency and the Insurance Health Plan to ensure a proper level of payment is assigned based on the acuity of the patient and the clinical needs of the patient
- Communicate the Care Plan to Insurance Case Managers with emphasis on the development of a strong discharge plan and smooth transition home for patients who will be discharged home
- Communicate the Insurance benefits under the policy to the facility associates who have a need to know and the patients and families
- Understand the provisions of the health plan coverage and what the associated inclusions and exclusions are from the policy
- Understand the costs analysis on a per patient basis and negotiates around the service needs of the patients and supports the development of an appropriate per diem payment
- Consult on appeals, retro authorizations, and collection issues
- Track assigned patient population over a 90 day episode that begins with admission to the SNF participating in Model 3; track the patients and monitor by the assigned DRG
- Work with providers including Hospitals, other facilitys, and Home Health Agencies to monitor care for the patient and coordinate treatment in an effort to reduce avoidable readmissions
- For patients readmitted to the hospital, work with Hospitalists MD to bring the patients back to the center as soon as patients are clinically appropriate in an effort to avoid a long hospital stay
- Track patients in the home setting with the goal of preventing hospital readmissions and when possible avoiding the Emergency Room
- Act as central point of contact for the patient and family during the 90 day episode, provide support and work at improving the Beneficiary Experience of Care
- Support and promote the care redesign program established to reduce the patient length of stay in the center and avoid hospital readmissions as much as possible
- Support assigned facilitys as they develop Care Paths and their Quality initiatives designed for certain DRG's.
- Utilize 90 day tracking software to monitor the patient and keep staff informed of relevant benchmarks
- Assist in service line development to improve care
- Document Case Mgt initiatives for the individual patients as they are identified at admission per company standards
- Review and incorporate in care plan information from provided reports
- Understand the cost drivers in the program and will work with the treatment team to provide guidance into alternative treatments to provide best outcomes and efficient care
- Work with hospital partners on patients admitted to the hospital in terms of returning them to center or agency as quickly as possible
- Utilize financial tools provided to support the goal of gain sharing for participants in the bundling program
- Understand the quality and performance measures for Medical Directors and Hospitals
- Assist the patient and family to navigate through the health care system over the 90 day episode
. Requirements:- High school diploma or equivalent
- Must hold and maintain a current license to practice as a Registered Nurse (RN) in state of consultation
- Minimum two (2) years clinical experience with understanding of post acute care
- Minimum three (3) years case management experience in a health plan or provider setting
- Current Certified Case Manager certification from the Commission for Case Mgt Certification, preferred
- Must be capable of maintaining regular attendance
- Basic Computer Skills regarding the use of email, and WORD; processing fax's and messages, email etiquette
- Good customer service skills for patients, families as well as health plans, home health agencies, and hospitals
- Ability to remain calm under stress and mediate conflicts over the phone
- Good coordination skills and timely follow-up responses to customer groups
- Ability to prioritize multiple tasks with changing levels of urgency
- Must be able to maintain confidentiality regarding patient, employee and company proprietary information
- Must have the ability to relate professionally and positively and work cooperatively with patients, families, and other employees at all levels