Location: Chicago, IL

Hospital: RUSH University Medical Center

Department: MHN Primary Care Case Mgmt

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

Shift: Shift 1

Work Schedule: 8 Hr

Summary:
The Care Management Navigator I is part of a care management team that is responsible for promoting effective resource utilization to achieve an optimal clinical outcome. The Care Management Navigator applies a collaborative approach in working with physicians, nurses, social workers, peers, leadership, community providers, payers, internal/external agencies and patients. As part of the larger Division of Care Management, the Navigator will provide supportive services to one or more areas within the Division. The Care Management Navigator may contribute to transitional care planning, utilization review, and/or service line growth & outreach efforts for a group of patients from a patient list. This role will share knowledge and education to empower patients and improve their ability to navigate services and systems utilizing the established model of care management. 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.

Responsibilities:
1. Daily monitoring of a list of inpatient discharges, ER discharges, and referrals.
2. Provide outreach for all patients due for follow up and new patient appointments according to policy and procedures.
3. Prepare and deliver routine correspondence/medical records to referring agencies and primary care providers in accordance with policy.
4. Document all correspondence in electronic medical records as necessary.
5. Liaison to multiple departments, agencies and provider offices.
6. Participate in meetings as assigned.
7. Conduct outreach and complete assessments as necessary to identify individuals at risk for adverse health outcomes including timely Health Risk Assessments
8. Provide assistance with insurance as needed, including helping patient connect with resources for enrollment, conducting verification of insurance plans, assisting patients with redetermination, and others as needed.
9. Coordinate transportation for all patients as needed
10. Facilitates collaboration with CM team/department, unit staff, and/or physician practice to prioritize tasks; ensuring strategic support needs and expectations are met.
11. Flexes schedule to meet department needs.
12. Assists with managing Medicare Important Message processes
13. Works with CM and Patient Access to ensure hospital compliance with federal mandates.
14. Coordinates post discharge care transition referral communication. In collaboration with the case manager, provides referral and follow-up contacts to agencies, facilities and patients/families to support safe, effective care transitions.
15. Identifies issues, resolves when able, triages to the appropriate level.
16. Provides designated support for functions including payer approval/certification communication, denial appeals, and/or level of care management processes. In accordance with the case management external faxing policy and HIPPA guidelines, communicates clinical information/PHI to payers to ensure certification of inpatient hospital stays via secure e-fax.
Other duties as assigned.

Other information:
Required Job Qualifications:
1. High School diploma or GED
2. Knowledge of ambulatory setting
3. Basic knowledge of Microsoft Office
4. Written, verbal and exceptional interpersonal communication skills
5. Ability to multi-task
6. Ability to function independently, to organize, and be self-motivated

Preferred Job Qualifications:
1. 1 or more year of experience in a health-related area of focus
2. Associates degree (health related area of focus such as social work, psychology or medical terminology)
3. Bilingual
4. 1 or more year of experience electronic medical records

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.