RN Full-time
Concord Hospital

Medical Home Nurse Navigator | Full Time | Days

Concord Hospital Concord, NH, US
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Summary

Under the general supervision of the Director, Medical Home Navigation Program, the Medical Home Nurse Care Manager (NCM) facilitates coordination of care and communication, supporting patients with complex medical, behavioral and/or social issues who struggle with chronic care management and coordination needs. Coordination of care is patient centered and designed to include all providers and locations of health care to maximize patient wellness and cost effectiveness of care.

Education

Graduate from an accredited Nursing program, BSN required.

Certification, Registration & Licensure

Licensure required: New Hampshire Board of Nursing license.

Valid NH driver's license, insurance and driving record from Department of Motor Vehicles that meets organization and departmental standards.

Experience

Minimum 3 years nursing experience; additional case management/care coordination experience preferred. Effective interpersonal, organizational and motivational skills required with ability to function as a team player, and proficiency in written and verbal communication.

Responsibilities

  • Identifies and enrolls eligible patients in the Medical Home Navigation service.

  • Assesses the health status of enrolled patients.

  • Develops and implements patient-centered care plans for accessing and coordinating needed care across

    the continuum.

  • Serves as the contact for team-based communication about patients on the case load.

  • Provides hospital discharge follow up for all patients in the case load.

  • Provides education to patients in response to identified patient needs.

  • Bases nurse care management actions by applying principles of purposeful, organized thinking to make

    sound clinical judgment/decisions.

  • Documents measurement and evaluation of financial, clinical, functional and satisfaction outcomes as

    patient progresses towards desired goals.

Concord Hospital is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, sexual orientation, gender, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.

Know Your Rights: Workplace Discrimination is Illegal

Applicants to and employees of this company are protected under federal law from discrimination on several bases. Follow the link above to find out more.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, you may contact Human Resources at 603-230-7269.

Physical and Work Requirements

The physical demands and characteristics of the work environment described here are representative of those that will be encountered by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The Dictionary of Occupational Titles Material Handling Classification is LIGHT. The employee must regularly lift, carry or push/pull less than 10 pounds, frequently lift, carry or push/pull up to 10 pounds, and occasionally lift, carry or push/pull up to 20 pounds.

While performing the duties of this job, the employee is regularly required to speak. The employee is frequently required to bend, do fine motor, do repetitive motion, hear, kneel, reach, sit, squat, stand, and walk.

Specific vision abilities required by this job include color vision, depth perception, far vision, near vision, and peripheral vision.

The employee is occasionally exposed to airborne contaminants, airborne pathogens, bloodborne pathogens, bodily fluids, and electrical hazards - shock.

The noise level in the work environment is usually moderate.

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