Care Navigator

SHENANDOAH VALLEY WESTMINSTER-CANTERBURY POSITION DESCRIPTION TITLE: Care Navigator DEPARTMENT: Health Services RESPONSIBLE TO: Director of Resident Services JOB SUMMARY: The Care Navigator helps residents coordinate and navigate their care across the care-continuum at SVWC. The Care Navigator is the first point-of-contact for families, discharge planners and other new, short-stay referral sources that are interested in placement in SVWC’s Healthcare Neighborhoods. REQUIRED EDUCATION, EXPERIENCE, SKILLS, LICENSURE Master of Social Work degree required. Experience in the medical field and sales/marketing preferred. Experience or knowledge of managed‑care pre‑authorization processes preferred. Highly motivated, energetic, and able to work both independently and under the direction of the Director of Resident Services. Multi‑tasker with excellent communication skills. UAI certification and experience preferred. JOB REQUIREMENTS Support the mission and purposes of SVWC. Support the Board of Trustees and Administration. Attend in‑services and meetings required by regulatory agencies or SVWC. Submit to employment and annual tuberculosis testing as required by Virginia State Licensure. Follow and support the policies and procedures established by SVWC. Adhere to professional standards of ethics at all times. Attend professional meetings, conferences and workshops to maintain awareness and knowledge of current trends that influence area of practice. ESSENTIAL DUTIES/RESPONSIBILITIES Healthcare Admissions Conduct psychosocial pre‑assessments for outside admissions and recommend appropriate level of care. Review and manage all referrals for admissions by screening patients by comparing patients’ condition to admission criteria; evaluating and accepting or rejecting patients; referring patients and families to other programs and institutions. Maintains frequent and open communication with local hospitals and referral sources regarding patient referrals, the status of referrals, and bed availability and to request any further information necessary to ensure a smooth transition of care from referring agency to Healthcare. Manages internal communication and admission processing that promotes excellent customer service. Coordinates transfers and paperwork to SVWC during episodes of hospitalization. Coordinates necessary internal transfers to higher levels of care. Obtains patient information from referral sources, patient, and/or family as needed; verifies and clarifies information for accuracy, reviews/completes admission contracts and completes EHR tasks in a timely manner. Support compliance regarding regulatory requirements and PACE partnership. Perform other duties as assigned. Resident Care Conduct psychosocial pre‑assessments for outside admissions and recommend appropriate level of care. Meet with resident and/or responsible party as needed to address and assist with psychosocial concerns. Act as resident advocate, helping resident, responsible party, and staff understand the social and emotional factors underlying residents or families’ mood and/or behavior. Prepare for and participate in discharge plans as necessary. Provides and/or arranges for outside professional interventions as appropriate for the resident; follow up to determine that appropriate documentation of the service has been requested. Visit residents outside of the facility when needed. Explore and utilize community resources as appropriate. Works in collaboration with the Interdisciplinary Team to identify resident care needs. Facilitates access to necessary medical and social services. Conducts annual Independent Living Residents’ assessments and assists in preparation for annual wellness visits with SVWC Clinic Providers. Utilizes ACO dashboard to coordinate provider recommendations. Ensures continuity of care by making follow‑up contact after services are provided. Supervisory Responsibilities The community’s Social Workers will report directly to this position. This position typically supervises a team of up to 2 employees. Attendance, Punctuality, and Versatility Adhere to current SVWC Attendance and Tardiness policies. Remains flexible to cover psychosocial needs of residents. Other Other duties as assigned. KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED Strong interpersonal and communication skills and the ability to work effectively with a wide variety of individuals within the facility as well as persons from the outside community. Interviewing and social work evaluation skills. Ability to maintain emotional stability to cope with human suffering, emergencies, and other stresses. Ability to make administrative/procedural decisions and judgments. Ability to lead and train staff and/or students as related to the Social Service department. TOOLS AND EQUIPMENT Must be able to use, operate, and interpret information from various online platforms, insurance portals, and hospitals’ EHR. UNIVERSAL PRECAUTION RISK CLASSIFICATION Category C: The person holding this position understands Universal Precautions Risk Classification categories apply to this position and the individual may be exposed to AIDS, HIV, and Hepatitis B viruses. Tasks that involve no exposure to Blood, Body Fluids, or Tissues. The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids.) PHYSICAL REQUIREMENTS Vision: Must be able to visually identify and discern printed words on either typewritten pages or computer screen. Must be able to identify and differentiate colors. Must have depth perception within normal ranges. Hearing: Must be able to respond to spoken words and other auditory sounds including the use of the telephone and ringing of beepers and monitors. Speech: Must be able to verbally communicate in the English language directly and over the telephone and be understood. Range of Motion: Must have mobility for all parts of the body, walking, bending, lifting, reaching above head and use of hands. Must have manual dexterity, fine motor skills (typing, computer, etc.). Lifting: Must be able to push and maneuver wheelchair occupied by a person. MENTAL CAPACITY: Must agree to protect the rights of the residents, including confidentiality and privacy. Must have mental capacity to fulfill the requirements of the job including problem solving, logic, communication and basic mathematical calculations. Must be able to use judgment in making decisions and choices. WORKING CONDITIONS: Must be able to work under stress. Must be able to work extra hours when needed (and some employees work rotation or call schedules). Must be able to work “on call.” (Some employees on occasion). Must be able to deal with verbally and physically combative residents. NOTE Note: This job description is not intended to be all-inclusive. An employee will also perform other reasonably related job responsibilities as assigned by management as required. Shenandoah Valley Westminster-Canterbury reserves the right to revise or change job duties as the need arises. Moreover, management reserves the right to change job descriptions, job duties or working schedules based on their duty to accommodate individuals with disabilities. This job description does not constitute a written contract of employment. #J-18808-Ljbffr