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Organization:

SPMF-Sutter Pacific Medical Foundation - South

Position Overview:

A professional registered nurse (RN) who offers individualized assistance to patients, families and caregivers to help overcome health care system barriers. Enhances the patient experience and improves the clinical outcome for patients by providing a seamless navigation process throughout the continuum of care. Responsible for collaborating with physicians and members of the interdisciplinary teams to triage, coordinate, and consistently manage patient care by educating the patient and serving as a point of contact for patients and families. Participates in strategic initiatives within the clinical program or service line to include developing, implementing and monitoring navigation activities and sustainability, facilitates shared decision making and patient engagement by forming trusting relationships and addressing patients' communication and health literacy needs, while helping them integrate their values and preferences into treatment decisions. Works for and promotes positive outcomes for patients, providers and the Sutter health care system.

Job Description:

These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).
JOB ACCOUNTABILITIES:
Coordinates patient care through the point(s) of continuum specified by assisting with timely access to care, coordinating/facilitating appointments and services, and accompanying patients to appointments as needed.
Facilitates timely coordination of appointments/services
Meets with patient by phone or in person "within designated time" following "designated event" and follows patient per facility-specific guidelines
May include meeting with the patient in both acute and non-acute Sutter Health locations. Coordinates appointments, if applicable, for diagnostic testing, services, and with providers to ensure timely delivery of diagnostic and treatment services. May include accompanying patients to appointments (particularly if there are multiple barriers to care) and/or, providing clarification and literacy-level appropriate education related to the visit.
Provides care coordination, symptom management support, guidance, education and advocacy across care settings.
Discusses physician visits with patients and families and answers questions
Provides and reinforces education re: treatment, care plan, symptom management, and survivorship concerns
Facilitates shared decision making and patient engagement by forming trusting relationships and addressing patients' communication and health literacy needs, while helping them integrate their values and preferences into treatment decisions.
Empowers patients with education and knowledge to help improve patient outcomes and satisfaction
Assesses patients' current and future needs, provides patient access to resources (internal and external), facilitates patient needs assessments, including distress screenings and acuity scales; coordinates/facilitates appropriate referrals.
Assesses for and identifies patient/family needs and matches unmet needs to appropriate resources during care continuum, based on clinical guidelines and evidence based practices.
Assesses for and works to mitigate barriers to care. Assists patients with access concerns (for screening, diagnosis, and/or treatment, as appropriate) and assists with paperwork as needed
Makes referrals for services based on patient/family needs-i.e., education, finances, psychosocial, survivorship, transportation, child care, lodging.
Facilitates access to physicians and services.
Facilitates appropriate medical record availability at scheduled appointments as needed. vi. Facilitates language translation or interpretation services. vii. Facilitates financial assessment and referrals along with assisting with completing forms as needed.
Facilitates linkages to follow-up services
As appropriate, facilitates screening for and access to clinical trials, molecular testing and/or genetic counseling. Builds partnerships with local agencies and groups (e.g., referrals to other services and/or support groups)
Facilitates distress and acuity screening and makes appropriate referrals
Establishes and maintains close collaboration with providers and care team to communicate effectively ensuring seamless patient care and care coordination.
Communicates and collaborates with involved physicians and staff members to facilitate individualized patient care plans and communication between care disciplines
Maintains communication with patients, families, and health care providers to monitor patient satisfaction with the care experience
Ensures that navigator functions and activities remain within scope of defined role
Provides triage and support services (e.g., symptom management, emotional support, education, resource referral) for patients//families in collaboration with attending physicians and the care team
Tracks navigation program metrics and quality indicators, documents patient interactions and progression, and communicates navigation activities to physicians and the care team
Assists with tracking, documentation, and outcome reporting for navigation services
Assists with ongoing navigation program assessment and identification of process improvement opportunities
Assists with and/or attends meetings for Sutter Health accreditation endeavors.
Assists with annual accreditation requirements related to navigation and as directed by administration.
Actively participates in multidisciplinary conference, assisting with preparing conference materials and providing patient follow-up as needed.
Actively participating in multidisciplinary care patient presentation and care planning
Assists with coordination of multidisciplinary conference(s) as needed
Assists with patient follow-up as needed
Assists with and/or attends conferences
Participates in community health promotion and awareness programs.
Conducts health promotion and awareness programs in community as appropriate
Attends community health fairs and screenings; provides community education presentations as appropriate
Facilitates/attends support groups as appropriate
Conducts and/or assists with a Community Needs Assessment at least once every three years to meet the American College of Surgeons Commission on accreditation requirement(s).
Teaches health topics, including risk reduction, to those interested within the community.
Facilitates and/or attends support groups.
Communication (Oral and Written)
Consistently communicates with patients, physicians and other Sutter Health staff in a courteous, professional manner that reflects the desired service outcomes of the department
Prepare patient information materials as requested
Maintains confidentiality of patient information at all times
Quality:
Participate in ongoing quality assessment/improvement, ensuring that there is a continuous process of measuring and enhancing quality
Consistently demonstrates Customer Service principles in daily practice
Must be detail-oriented and possess strong organizational skills
Must possess excellent follow-up and follow through skills
Participate in ongoing education opportunities and training
Productivity/Efficiency:
Ability to prioritize goals and work accurately and efficiently
Sutter Health Citizenship:
Adheres to all policies and procedures (i.e. Administrative and Human Resources), practices safe work habits, and engages in good business standards and practices.
Service Standards
Consistently exhibits behaviors set forth in the attached Sutter Health Codes of Conduct
EDUCATION:
Other: Graduate of an accredited school of nursing.
CERTIFICATION & LICENSURE:
RN-Registered Nurse of California
BLS-Basic Life Support Healthcare Provider

DEPARTMENT REQUIRED CERTIFICATION & LICENSURE

Department, Oncology: ONC-Oncology Nurse Certification (may also be CPHOB, CBCN, BMTCN, APHON or AOCNP) if required by entity (within 1 year with 1 year oncology experience or within 2 years with less than 1 year oncology experience)

Department, Oncology: ONS Foundations of Oncology Nursing Practice within 90 days (if less than 1 year with oncology experience)
TYPICAL EXPERIENCE:

5 years recent relevant experience.
SKILLS AND KNOWLEDGE:
Knowledge of medical terminology required.
Ability to ensure follow through with responsibilities and communicate with a varied level of health care staff.
Knowledge of third-party reimbursement helpful.
Verbal and written communication skills.
Microsoft Office software experience required, including Excel and Word
PHYSICAL ACTIVITIES AND REQUIREMENTS:
See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements

For onsite employees: Job Requirements

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

40

Employee Status:

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $86.68 to $114.41 / hour

The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.