Care Navigator, MSW - Meridian Village - FT Days

Job Description: 

Summary:

Responsible for identifying appropriate resources/services in conjunction with assisting residents to live in the least restrictive level of care coordinates and conducts needs evaluation of residents and provides recommendations where appropriate.  Develops relationships internally and externally to support key initiatives and alignment with healthcare strategies.  Supports and coordinates referrals when transitioning from one level of care to another to ensure resources/services are sufficient to meet the resident’s needs.

Essential Duties and Responsibilities:

1. Assists and supports residents in transitioning to the appropriate level of care and in the least restrictive level of care as illustrated by performing the following job duties:

• Identifies residents who have requested, may be appropriate for or wishes to transition from one level of care to another permanently or for a short stay (less than 100 days)
• Assists in determining the most appropriate level of care based on the care and services needed
• Identifies and assists with arranging services needed to provide a resident with the ability to live in the least restrictive level of care
• Develops and maintains key business partnerships to support key initiatives and alignment with healthcare strategies
• Develops relationships with campus team members, business partners, residents and medical professionals to encourage the identification of residents requiring an evaluation, additional resources, or plan a transition in care levels and/or update wellness plan
• Facilitates ongoing education with residents about community resources and disease management
• Evaluates individuals to determine appropriate care transition. Identifies potential barriers to transition and assists in developing a  plan to address them all
• Counsels residents who are being admitted or discharged regarding their level of care; identifies and refers to the appropriate services
• Coordinates referrals
• Provides site visits to facilities to meet with current residents to determine appropriate level of care upon admission or re-admission
• Completes all paperwork and reporting as required
• Conveys difficult decisions to resident and/or family in a tactful, diplomatic manner

2. Plans, directs, coordinates, controls, and leads the assigned area of responsibility and provides leadership to colleagues in a manner that is consistent with gracious service and hospitality and the mission of Evertrue, while complying with all formal policies and regulatory requirements

3. Coordinates specific work tasks with units and departments in order to ensure the smooth and efficient flow of information

4. Reports pertinent information to the immediate supervisor as requested, or according to an established schedule; compiles information as necessary or as directed and provides data to appropriate personnel

5. Provides excellent customer service by interacting and responding to needs/requests/issues of employees, families, contractors, colleague agencies, volunteers, visitors and/or the general public

6. Maintains awareness of all services offered by EverTrue; takes appropriate action to actively promote, support and communicate them to prospective clients, residents and families

7. Participates in meetings and on task forces, committees, etc., as assigned

8. Coordinates vaccine clinic(s) i.e. annual flu, COVID 19 as recommended by the CDC

9. For those residents with Managed Care Insurance: Apply for and receive Part B Healthcare benefits for independent living and personnel care residents where applicable; i.e. to include nursing services, occupational, speech, and physical therapy

Qualifications, Knowledge, Skills & Abilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

• A degree in Social Work Healthcare or related field or a Registered Nurse (RN) or Licensed Practical Nurse (LPN).
• 2 or more years in Post Acute Care as a Social Worker or relevant healthcare experience

Physical Requirements and Working Conditions

The physical requirements and working conditions described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

While performing the duties of this job, the employee is occasionally required to stand; walk. The employee frequently is required to use hands to touch, handle, or feel objects, tools or controls; reach with arms and hands, climb or balance; sit and stoop, kneel, crouch, or crawl. The employee is constantly talking or listening.

• Must be able to lift up to 30 lbs.
• Must be able to push/pull 30 lbs.

The work environment is a well-lighted and ventilated area that has its own temperature control system (air conditioning and heat).  The noise level is moderate.

This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position.  Employees may be required to follow other job-related instructions and to perform other job-related duties as requested, subject to all applicable federal, state, and local laws and standards and EverTrue policies and procedures.

Additional Information:

N/A