The Nurse Navigator is responsible for overseeing the collection and distribution of key clinical, demographic and treatment information for prospective patients who may be treated with non-surgical or surgical modalities. Their role is that of a single accountable staff that coordinates and communicates patient care status among spine professionals, insurers, primary care physicians and the patient. The Nurse Navigator facilitates the development, implementation and maintenance of systems that promote desirable patient outcomes. Assists in the development and communication of packaging pricing. This position is additionally the single point of contact for the implementation of the Department of Labor Utilization Guidelines for the organization and for workers compensation insurers, and for care navigation needs of the patient with workers compensation insurance.

NON-EXEMPT

Receives and processes messages from the spine and orthopedic service line phone and email/web access points.

Responds to l Inquires for services for care navigation services, package pricing, and utilization guideline implementation.

Coordinates the collection and distribution of key clinical, demographic and treatment information for prospective patients, to providers, insurers, and consultants per regulations and guidelines.

Performs a case manage assessment for multiple sources ( patients, providers, insurers/payers).

Knowledgeable about package pricing and is able to complete the evaluation based on clinical assessment of procedures for applicable package pricing.

Works collaboratively with all providers and their offices to provide excellent customer service.

Works closely with Patient Business service to assure that pre-paid policies and procedures are followed.

Maintains department records and files.

Coordinates and develops programs that assist the delivery of the highest quality, effective and efficient care.

Includes the development and delivery of education to patients, insurers, physicians and staff.

Maintains a working knowledge of Montana statues and administrative rules pertinent to the care of the worker with an injury of disease. Is able to assist provider offices in the application and implementation of these regulatory pieces.

Maintains a good working relationship with worker compensation insurance carriers and third-party administrators.

Position supports continuous quality improvement, accreditation standards, state and federal regulations, and health information fundamentals

Facilitates patient access to community resources as appropriate.

Maintains a good working relationship within the department and with other departments.

Treats patients and their families with respect and dignity.

Demonstrates the ability to be flexible and organized.

Demonstrates the ability to deal with pressure to meet deadlines, to be accurate, and to handle constantly changing situations.

Demonstrates the ability to deal with a variety of people, deal with stressful situations, and handle conflict.

Performs other duties as assigned.

Professional Requirements:

Adheres to dress code.

Completes annual educational requirements.

Maintains regulatory requirements.

Wears identification while on duty.

Maintains confidentiality at all times.

Attends department staff meetings as required within the department.

Reports to work on time and as scheduled; completes work in designated time.

Represents the organization in a positive and professional manner.

Actively participates in performance improvement and continuous quality improvement (CQI) activities.

Coordinates efforts in meeting Joint Commission, federal, state and local regulations and standards

Communicates and complies with the Benefis Health System Mission, Vision and Values as well as the focus statement of the department.

Complies with Benefis Health System Organization Policies and Procedures.

Complies with Health and Safety Standards and Guidelines.