LVN Navigator Care Coordination

LVN Navigator Care CoordinationDignity HealthRancho Cordova, CaliforniaRequisition ID 2022-276537 Employment Type Full Time Department Care Coordination Hours/Pay Period 80 Shift Day Weekly Schedule Monday through Friday Remote Yes Category Case Management and Social WorkOverviewCommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.ResponsibilitiesThis is a remote positionJob Summary / PurposeThe Post-Acute Care (PAC) Transition Nurse is an integral part of the Care Coordination Team, responsible for ensuring timely and appropriate transition through the continuum of care, from the point of contact through discharge to a home setting on assigned patients. The PAC Transition Nurse performs this role in such a manner as to meet the individual’s health needs while promoting quality and cost effective outcomes. Through assessments to determine unmet needs, the PAC Transition Nurse evaluates and identifies knowledge gaps of disease process and treatments, determines appropriate resources or services required to meet an individual's health needs, provides education/coaching on disease self-management for health promotion and maintenance, monitors patient's progress, promotes quality cost effective outcomes with the goal of improved care coordination amongst providers and increased involvement of the individual/family/caregiver in the decision making process to reduce hospitalizations, readmissions and ER visits. This position will involve telephonic direct patient contact, in collaboration with acute care coordination, ambulatory care coordination, physicians, post-acute program managers, and post-acute service providers. The PAC Transition Nurse will advocate for the patient and family by identifying and valuing patient goals of care, spiritual needs, cultural, language and socioeconomic barriers to care transitions. In addition, the PAC Transition Nurse will protect confidentiality while striving to achieve high levels of patient satisfaction.Essential Key Job ResponsibilitiesThe PAC Transition Nurse identifies assigned patients transitioning to post-acute setting and ensures collaboration with receiving facility

Interacts with patients and family providing transition plans for treatment goals and post-discharge needs.

Concurrently reviews patient’s records to collect data to carefully understand the needs of the patient by scrutinizing their background history, understanding their current needs, and arranging for their wellbeing.

The PAC Transition Nurse advocates for the patient and the patient’s goals of care, helps to identify and address social determinants of health, ensures that follow-up appointments are in place, advocates for the appropriate next level of care, obtain community resources and services and prepares a hand off to ambulatory care coordination

The PAC Transition Nurse works closely with post-acute providers to identify opportunities to decrease readmissions, improve care transitions, and solidify relationships within the care continuum.

Assists patients with navigating the healthcare system to minimize fragmentation in services, obtain timely care and appropriate access to providers, services and necessary procedures.

The PAC Transition Nurse is accountable for accurate and timely documentation of efforts.

Other duties as assigned.

#missioncritical#LI-DH#LI-REMOTE#carecoordination#lvn#lpn#remoteA compensation range of $55,000 to $76,000 is the reasonable estimate that CommonSpirit in good faith believes it might pay for this particular job based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility and more!QualificationsRequired Edcuation and ExperienceMinimum of 3 years nursing experience in an acute hospital setting, post-acute setting, or ambulatory care setting required

Case management, discharge planning, transition management and/or utilization management experience required

Current Licensed Vocational Nurse (LVN) license in the state of CA.

Understanding of assessment tools such as InterQual and Diagnosis Related Groups (DRGs) preferred.

Equal OpportunityCommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed toa diverse and inclusive workforce. All qualified applicants will be considered foremployment without regard to race, color, religion, sex, sexual orientation, genderidentity, national origin, age, disability, marital status, parental status,ancestry, veteran status, genetic information, or any other characteristic protectedby law. For more information about your EEO rights as an applicant,pleaseclick here. (https://tbcdn.talentbrew.com/company/35300/img/v10/EEOCKnowYourRightsEnglish.pdf)CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c).External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA).CommonSpirit Health™ participates in E-Verify.Equal OpportunityCommonSpirit Health™ is an Equal Opportunity/ Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law.