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About the Role

The LVN Navigator supports Central Health's Transitions of Care (TOC) programs by providing healthcare system navigation for patients discharging from acute care facilities, ensuring a smooth transition. This role also manages incoming referrals for post-acute care services and assists patients through inbound/outbound call support.

Responsibilities

• Assist hospital staff, community partners, and Central Health Transitions of Care teams in navigating patients recently discharged from the hospital or other acute care facilities with securing appropriate medical care, Transition of Care (TOC) support, or other health care related assistance.
• Manage incoming referrals for transitions of care from community partners needing to access Post-Acute Care services, such as Transitional Dialysis, Case Management, and educational programs.
• Support discharge and transitions of care planning to the next level of care by facilitating home health referrals, DME needs, expedited MAP enrollment, and appointment scheduling.
• Serve as a primary Central Health Navigation Center contact for external providers (hospital, specialty and ER) and for patients of Central Health upon discharge from hospital or ER.
• Provide telephonic coverage and support within the Central Health Navigation Center for inbound calls, email, and HIPAA compliant hospital SMS platforms pertaining to post-acute care service line patients, including Transitions of Care, Medical Respite, and Case Management.
• Support programmatic activities such as clinical review of incoming referrals for services like specialty care and diagnostic services, and review of daily triage patient encounters.
• Provide medical telephonic coaching, information, and educational materials and resources to patients as needed.
• Educate discharge planners, physicians, and other appropriate referral sources regarding Central Health programs and programmatic criteria requirements.
• Enhance the patient experience by practicing AIDET during each patient interaction.
• Interact respectfully and collaboratively with patients and their families, striving to develop favorable relationships.
• Ensure all tasks involving patient care, patient administrative processes, and related duties comply with all regulatory and accreditation standards, departmental protocols, and assigned worksites’ policies, procedures, and standing operating procedures.
• Adhere to State Board of Nursing and State Nurse Practice Act requirements and other governing agency regulations.
• Attend staff meetings and education offerings both in person and via teleconference/online as required.
• Support organizational initiatives to promote and maintain a strong positive workplace culture.
• Participate in continuous quality improvement projects to better serve the patient, family, and healthcare system.
• Perform other duties as assigned.

Requirements

• 2 years experience working in a community-based organization, ambulatory clinic, home health, or hospital setting.

Skills

• High level of skill at building relationships and providing excellent customer and patient care.
• Ability to facilitate patient access across the healthcare continuum.
• High level of problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to work collaboratively with both internal and external medical staff and external partners and organizations.
• Strong commitment to quality, efficiency, and effectiveness.

Location

• Austin, Texas area

Work Type

• Hybrid

Education Level

• Graduation from an accredited school of Vocational School of Nursing