A Benefis Health System Navigator receives referrals from either community entities or a Benefis entity for request of services. The Navigator is considered the expert in their service area. The Navigator screens referrals for appropriateness of services requested by a referral source, both medical necessity and payer source coverage. The Navigator works with their service line intake staff to determine pre-authorization needs and medical necessity needs for service requested along with compiling all necessary documentation required for payer coverage. The Navigator will assess, plan and evaluate the needs of the patient and will collaborate and communicate with providers, case manager, nursing staff and entire multi-disciplinary care team to support requested services. The Navigator will communicate any changes in the patient's medical condition that may impact their care plan and the outcome of the referral received for the specific service need. Based on approval or denial of service line referral request, Navigator meets with patient/family/legal representative to explain reasoning of denial or acceptance and expectation. Navigator explains what service line will entail and what the patient/family/legal representative can expect from their services, time lines for new start or scheduled appt., provides necessary education, completes new start paperwork and obtains patient/family/legal representative signatures as required. Navigator assists in setting up transportation if necessary. If accepted for services, Navigator becomes point of contact for patient/family/legal representative until the point in time in which services begin with another navigator or transition of care is completed.

NON-EXEMPT

Receives and responds to referrals from IP/OP case management and/or providers

Screens patient/ for medical necessity, along with documentation for qualification to service

Communicates referral results, whether patient qualifies or not

Screens patient for insurance coverage/non-coverage of requested service and obtains intake/new start paperwork signatures from patient/POA/Guardian

Assessment of resources available to patient for support and compliance with treatment plan, to include setting up transportation as needed and additional support resources as needed, such a financial assistance and medication assistance

Liaison activities with in the healthcare system, care team, and patient to facilitate a continuum of care

Works with service line staff to get necessary notes/paperwork/orders required to start service or submit for insurance authorization

Once patient determined to qualify for services, navigator accountable for coordination of care until which time patient is established with services, to include appropriate follow- up appointments and visits as recommended

Reviews and meets timelines/expectations, to include meeting plan of care guidelines and provide communication with appropriate individuals to include providers, PCP and patient/family

Provide patient/family education on the services that will be provided

Develop patient education and tools focused on specific service

Completes face to face meeting with patient/family - inform of services, what to expect, answer questions related to specific service

Serve as the Point of contact for the patient and family communication/coordination for services

Maintains excellent working relationships with physicians, customers, and other health care organizations

Responsible for outreach efforts to establish and maintain positive working relationships with key physicians, office staff, and Benefis healthcare team.

Communicating patient status to providers, primary care providers, patient and family

Participates in patient care conference as needed

Participates in discharge planning meetings with service line staff and case managers as appropriate

Expert in their service line

Must be able to work in a self-directed environment, with ability to work with and lead teams.

Demonstrates knowledge of cardiac medications and administration, laboratory results, cardiac disease processes and treatments.

Assists in orientation of new staff.

Accepts other duties as assigned

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.

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 regulatory compliance, 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.