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RN Navigator - Health At Home Services

Company: Common Spirit
Location: Chandler
Posted on: January 25, 2023

Job Description:


#The Power to Advance Care in the Home

Do you know the inner-workings of the hospital discharge process? Are you familiar with Home Health and Hospice? Are you a Care Coordination Guru?

We're trying to get patients out of the hospital sooner. And we've found the secret to making it happen. Our Health at Home Navigator! Be a key contributor to getting patients home quicker to the right level of care, at the right time. As part of the Dignity Health Care Coordination team inside the hospital, the Home Health Navigator educates pre-identified, at-risk patients about home-based services, preparing patients and families for their journey home.


The Health at Home Navigator (HHN) has expert knowledge of geriatric home-based services, including home health, hospice and home infusion, and is an integral member of the hospital's health care team. The HHN will work with home-based service providers to increase the opportunity for timely discharge to home. Collaborate with physicians, Care Management, and other hospital team members to facilitate the discharge plan of care and enhance the quality of clinical outcomes while increasing patient satisfaction.


* The HHN works within the hospital and will guide patients through to care in the home upon discharge.
* Works with and alongside hospital partners to identify and prioritize patient populations who will benefit from post-acute services.
* Guides patients through and around barriers within the healthcare system.
* Identifies opportunities to reduce both financial and clinical risks to patients and families who have been discharged from the hospital.
* Acts as an active participant in multidisciplinary hospital/facility rounds as a patient advocate to ensure efficient continuity of care throughout the continuum.
* Collaborates with physicians and staff around care planning.
* Communicate pertinent care destination information and the home services candidates who were identified to the case manager and/or social worker.
* Maintains communication with patients, families, and health care providers to monitor patient satisfaction.
* Facilitates follow-up services with home services providers.
* Maintains documentation of coordination of home services.


* Active registered nurse (RN) license in state of practice, and/or Licensed MSW from an completed accredited MSW program
* Home Health and Hospice experience and/or knowledge is required.
* Combination of Acute and/or Post-Acute care delivery experience preferred.
* Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost).
* Must have strong organizational (time management) skills and the ability to handle multiple priorities.
* Excellent communication skills and the ability to interact with nurses, physicians and skilled healthcare professionals.
* Ability to work autonomously within a matrix environment without direct supervision or support.

Keywords: Common Spirit, Chandler , RN Navigator - Health At Home Services, Healthcare , Chandler, Arizona

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