Job Description

Job Title:                       Clinical Navigation Supervisor

Reports To:                   Clinical Quality Manager

Job Summary:                     Collaborates with clinical team members, patients, and families to facilitate unmet health care needs within the context of the Patient Centered Medical Home (PCMH) model.

                                                                                                                                                                       

Essential Job Duties and Responsibilities:

The job duties and responsibilities listed below are representative of the knowledge, skill, and/or ability required.  Other duties that fall within the broad scope of this classification may be assigned.

  • Supervises Care Coordination Program
  • Facilitate hiring, training, evaluating, and conducting disciplinary actions and other personnel actions as required.
  • Collaborates with patient care teams to develop patient education tools for the management of chronic conditions.
  • Facilitates and promotes orientation, operational training, hands-on coaching, and other staff development tools and resources for care coordination and monitors performance.
  • Assists in developing and implementing care coordination policies and procedures.
  • Ensures compliance with relevant grant reporting requirements.
  • Ensures staff follow up on outstanding referrals and diagnostic reports.
  • Oversees Care Coordination schedules in Practice Management, to include opening and closing schedules.
  • Builds and maintains relationships with specialists and other medical services.
  • Maintains a comprehensive, current database of community resources.
  • Performs clinical care coordination duties as needed.
  • Promotes the PCMH Model
    • Assists in promoting and implementing PCMH initiatives.
    • Regularly participates in leadership, staff, and other quality improvement meetings to educate staff and facilitate participation in PCMH initiatives.
    • Represents CCHCI’s implementation of PCMH within the context of institutional and community forums.
    • Other Quality Department projects as assigned.

 Promotes and Provides Care Coordination

  • Direct Supervision of Care Coordinators and Care Coordination Schedulers.
  • Audits his/her direct reports for timeliness, production, quality of documentation and reporting/leaving work at the time directed.
  • Approves/Manages direct reports, time sheets and PTO requests.
  • Coordinates preventative health care measures and health care maintenance for defined patient populations.
  • Manages insurance company correspondence regarding patient care.
  • Identifies and tracks patients in need of follow up and other testing for chronic disease management in collaboration with provider.
  • Follows up on missed appointments for defined patient populations.
  • If within scope, provides patient education for disease management and assists providers with lab and diagnostic study follow up.
  • Organizes and facilitates care planning for defined patients.
    • Arranges in-home medical care such as home health, hospice, and in-home durable medical equipment and oxygen needs.
  • Facilitates hospital admissions.
  • Tracks and coordinates follow up of hospitalized patients upon discharge and obtains in-patient medical records. Read and Interpret Patient Care Opportunity Reports (PCOR) and Gaps in Care Reports from various contracted insurance carriers. Use reports to dictate workflow.

 Coordinates Specialty Care

  • Builds and maintains relationships with specialists and other medical services.
    • Negotiates rates for underinsured and uninsured populations.
  • Follows up on outstanding referrals.
    • Assists patient with potential barriers to specialty care.
  • Coordinate in-house clinics for visiting specialists in collaboration with leadership team.
    • Manages and submits necessary documentation to insurance for coverage of transportation.
    • Negotiates rates with local transportation companies for uninsured populations.

 Utilizes Community Resources

  • Maintains a comprehensive, current database of community resources.
  • Facilitates communication with community organizations as a patient advocate.
  • Organizes support groups.
  • Manages funds set aside to assist patients according to established guidelines.
  • Facilitates completion of patient paperwork and applications.

 Minimum Qualifications - Education, Experience, Certificates & Licenses in addition to Care Coordinator II:

  • Minimum requirement of a bachelor’s degree or Licensed RN and at least five years of experience in case management, care coordination, nursing, or other related health care field.
  • Any combination of education and/or experience that provides the necessary skills and sensitivity.
  • CPR certification may be required for licensed staff.
  • Valid Fingerprint Card required.

 Preferred Qualifications – Education and Experience:

  • Master’s degree in a field of case management, project management, clinical care, care coordination, social work, or related field preferred.
  • HEDIS Certification.
  • Lean Six Sigma - Green Belt Certification within 6 months from hire date.
  • Working knowledge and navigation of Azara (DRVS). Run queries, interpret reports, and utilize Azara reports to dictate workflow.
  • Complete Advanced MS Excel class offered by CCHCI within 3 months from hire date.

 

Required Language Skills:

  • Ability to comprehend and compose instructions, correspondence, and communications in English in both oral and written format.
  • Bilingual in English and Spanish is preferred, but not required.

 Physical Requirements:

  • Ability to frequently exert enough force to move objects weighing up to 25 pounds.
  • Ability to continuously remain in a stationary position.
  • Ability to frequently move about inside the workplace to assist patients, operate office or medical equipment, etc.
  • Possesses hand-eye coordination and manual dexterity necessary to constantly operate computer, telephone, and other office machinery.
  • Possesses close visual acuity necessary to accurately record and view information on a computer monitor, handwritten and typed documents.
  • Ability to discern the nature of sounds at a normal spoken volume.

 Other Required Knowledge, Skills, and Abilities:

  • Assist patients with transportation arrangements.
  • Assists patients with medication assistance via the drug manufacturers.
  • Ability to add, subtract, multiply and divide in all measure, using whole numbers, common fractions, and decimals.
  • Ability to compute rate, ratio, and percent and to draw and interpret graphs.
  • Ability to skillfully gather and analyze data.
  • Ability to perform a variety of assignments occasionally requiring independent judgment.
  • Ability to identify and resolve problems in a timely manner.
  • Knowledge of health plans and community health centers preferred.
  • Knowledge of HIPAA rules and regulations.
  • Computer literacy required with proficiency in use of all Microsoft Office programs.
  • Ability to prioritize and plan work activities, use time efficiently and develop realistic action plans.
  • Assist with the training of Care Coordinator I in the use/operation of Azara, Nextgen recalls, and other duties as
  • Assist with data tracking to enable a more proactive and predictive model for gaps in care.
  • Assist with supervision of staff as directed.
  • May assist with the training of Care Coordinators and/or Schedulers in the use/operation of Azara, Nextgen recalls, and other duties as assigned.

Work Environment & Conditions:

  • Work environment is typical of a health clinic setting with occasional exposure to communicable diseases, bodily fluids, and hazardous chemicals.
  • Occasionally, work requires extended hours to include early mornings, evenings, and weekends.