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Job Description

Business Unit: Rush Medical Center

Hospital: Rush University Medical Center

Department: Care Management

**Work Type:** Full Time (Total FTE between 0.9 and 1.0)

**Shift:** Shift 1

**Work Schedule:** 8 Hr (8:30:00 AM - 5:00:00 PM)

Rush offers exceptional rewards and benefits learn more at our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits).

**Pay Range:** $21.61 - $34.04 per hour

Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush’s anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.

Summary:

The Care Management Navigator II is part of a care management team that is responsible for promoting effective resource utilization to achieve an optimal clinical outcome. This position works collaboratively with physicians, nurses, social workers, peers, leadership, community providers, payers, internal/external agencies and patients to provide transitional care planning, utilization review, and/or service line growth & outreach efforts for a group of patients from a patient list. This role includes scheduling procedures and outpatient provider appointments as part of the responsibilities. Insurance prior authorization will also be an expectation. In addition, this role will share knowledge and education to empower patients and improve their ability to navigate services and systems. The individual who holds this position exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures, including complying with all Rush University Medical Center Customer Service Standards.

Other information:

Required Job Qualifications:

• High School diploma or GED and 3 or more year of experience in a healthcare or hospital ambulatory related setting.

• 2 years of navigator or a combination of a navigator and care coordinator experience with Comprehensive knowledge of multiple aspects of the program to provide coverage as needed for missing navigators

• 2 years of experience with electronic medical records

• Demonstrated knowledge and/or experience with case management-related service functions such as: patient interviews, discharge planning/social service basic assessment and referral processes, community resources, finance and payer communication processes and information systems.

• Proficiency with basic Microsoft Office programs required

• Advocacy, Cultural Mediation/Competency

• Written, verbal and exceptional interpersonal communication skills including providing emotional support and information for patients, helping patients understand their diagnoses, and maintaining communication with patients, families and health care providers to monitor patient satisfaction with the care experience

• Ability to multi-task, function independently, organize, and be self-motivated.

Preferred Job Qualifications:

• Bachelors or Associates degree (health related area of focus such as social work, psychology or medical terminology) preferred.

• QBS Certification preferred if bilingual

Physical Demands:

Competencies:

**Disclaimer:** The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.

Responsibilities:

Job **Responsibilities:**

1. Develops action plans and basic care planning for low-risk patients.

2. Monitors a list of inpatient discharges, ER discharges, and referrals. Assists patients to assess transportation needs and other barriers to attend appointments. Implements necessary interventions to ensure patients have support and resources to support successful appointments.

3. Monitors and provide patient outreach as necessary to ensure care is delivered in a timely basis.

4. Aids with insurance needs and helps connect patients with resources for enrollment. Conducts verification of insurance plans and assists patients with redeterminations as needed.

5. Improves and further develops existing workflows.

6. Educates patients on available resources and be knowledgeable of available SDOH programs. Addresses SDOH concerns with education, connection to resources to patients who stratify as low risk.

7. Ensures compliance with quality measures to improve identified outcomes (i.e. Health Risk Assessment, high utilizer patients, etc.)

8. Assists in managing patient caseloads for the team and updates team on a monthly basis. Collaborates with team, department, unit staff, and/or physician practice to ensure expectations are met. Participates and contributes to an inter-professional departmental committee.

9. Provides training and orientation for Case Management Navigators 1, creates reference materials and shares expertise with others.

10. Provides services that may include but limited to patient centered interviews, transitions in care screenings, post discharge needs and presentation of patient resource folder and documentation of findings. Facilitates communication with Care Manager and team.

11. Ensures compliance with HIPPA and Release of Information regulations and protocols. Manages Medicare Important Message processes and related tasks. Works with CM and Patient Access to ensure hospital compliance with federal mandates.

12. Identifies issues and resolves when able Triages to the appropriate level and collaborates with senior management/leadership, case managers, nurses, physicians and general staff throughout the medical center to resolve care transition issues.

13. Contacts payers to obtain or confirm fax and contact information for certification nurses. Follows protocols and HIPPA compliance regulations and proposes process improvements to managers when issues are identified. Follows protocol and reports known or suspected misdirected fax incidents to certification supervisor/manager.

Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

**Position** Care Management Navigator II

**Location** US:IL:Chicago

**Req ID** 20213