Shs-Pop Health Nurse Navigator

Description:

Positions Location: East Lansing, MI

Job Description

General Purpose of Job:

As a mission-driven health system, a cornerstone for the organization is providing access to care for the underserved. As part of a multi-departmental effort, the Population Health Service Organization (PHSO) will be expanding the Mobile Health Clinic (MHC) service area, to include the larger Sparrow Health System (SHS) footprint across mid-Michigan. As a core member of a rotating inter-disciplinary team, the PHSO is looking for a Nurse Navigator to manage the day-to-day clinical and operational activities to ensure the highest quality care is provided to a population in need of additional support. From a logistical standpoint, the goal is to have the MHC out twice a week for events during the months of March through November.

Common Duties and Responsibilities:

In addition to the MHC events, the Nurse Navigator will also be responsible for facilitating/coordinating a quarterly Community Stakeholder Engagement Workgroup to understand partnership opportunities in the neighborhoods we serve. The individual will also act as a liaison to ongoing Sparrow Foundation initiatives and larger health system requests. Finally, with support from the internal care management team, the Nurse Navigator will be assisting with Emergency Department (ED) discharge calls for those individuals identified as high risk.

Essential Duties

This job description is intended to cover the minimum essential duties assigned on a regular basis. Caregivers may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

General Tasks

• Oversees the logistics of the MHC, working closely with Dean Transportation, the Resource Coordinators, and Sparrow Attendings/Residents to coordinate outings and services provided

• Coordinates the Sparrow MHC to deliver screening services, immunizations, behavioral health consultations, prenatal care, and Primary Care Physician (PCP) visits to medically underserved communities in Sparrow's service region

• Clinically screens, assesses, and evaluates patients for attending PCPs

• Responsible for charting and tracking in Epic, documenting follow-up appointments and a plan of care in a clear and concise manner

• Coordinates and provides education, information and support to patients based on their current conditions, concerns or issues

• Always works in collaboration with the multidisciplinary team

Specific Care Management-Related Tasks

ED or MHC Assessments

• Educates and supports staff in performing a comprehensive assessment

• Screens selected cases to identify needed services and interventions to deliver quality comprehensive care that addresses the patient's full range of health care needs

• Identifies issues, which may impact medical outcomes based on a comprehensive assessment that may include the patient's medical condition, support systems, finances, living situation, housing, behavior, cognition, function and abilities, and the patient's choices and preferences

• Works with staff as part of an Interdisciplinary Team, develops and implements a plan which addresses problems and needs identified in the assessment and ensures continuity of care by:

• Assists patient and family with access to appropriate resources and services based on a thorough knowledge of community resources and eligibility requirements

• Advocates on behalf of patients and their families with internal/external resources and payers (if applicable) for needed services, including negotiating with insurance companies for non-covered benefits

• Communicates with patients, families, members of the health care team and others in a professional, diplomatic and empathetic manner

• Provides clear, concise, timely written documentation on the patient's medical record and on departmental records

Self-Management

• Actively works with patients to use self-management goal-setting techniques, and develops action plans to encourage self-care

• Assists the patients and/or families in recognizing and prioritizing the problems that need to be addressed

• Providing support to help patients and/or families cope with the disruptions and distress associated with managing their illness

• Problem solves with patients and their families to maximize their ability to follow preventive, remedial and/or rehabilitative recommendations

Care Coordination

• Coordinates care with payer case manager (if applicable) for patients with complex or catastrophic conditions

• Facilitates follow-up with patients as needed to ensure patients understand self-care and treatment expectations

• Assists in developing a process to track care coordination activities

• Assists in developing written procedures and/or guidelines on care coordination processes and trains

Job Requirements

General Requirements • Registered Nurse with an active and unrestricted Michigan license • Valid driver's license • Basic Life Support (CPR) Work Experience • Minimum two years clinical experience • Proficiency with MS Word, Excel, Project, and Power Point required. Other software includes Visio, Enterprise Project Server, SharePoint. • Experience in public health preferred • Experience in care management preferred • Experience or knowledge of community support resources preferred • Experience in developing clinical workflows preferred • Experience in women's health, prenatal and contraception care preferred • Bilingual speaking in Spanish and English preferred Education • Bachelor's Degree in Nursing or health care related field OR must complete within 2 years of hire. Specialized Knowledge and Skills • Demonstrated interpersonal and communication skills, written and verbal • Demonstrates positive team attitude and has interpersonal skills to effectively and appropriately communicate with clients, families, physicians and other co-workers • Ability to work with diverse staff and patient populations • Highly organized • Ability to work independently and manage multiple tasks/events simultaneously

Sparrow Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.

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Location: Sparrow Hospital

Activation Date: Friday, February 16, 2024

Expiration Date: Saturday, July 26, 2025

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