RN - Nurse Navigator-TC-3

Summary

This position will be working with the department’s Tucson Collaboration Community Care program (TC3), a collaboration between TMC and Tucson Fire Department. The intent of the program is to provide call mitigation of unnecessary 911 calls and redirect these callers to the appropriate agencies and community resources. Reducing unnecessary 911 calls is part of the department’s resource and service efficiency plan. This position will process referrals from field crews and manage a caseload of clients that may include medical, behavioral health and substance abuse disorders with various and dynamic needs. Navigators are part of a multi-disciplinary team to coordinate a plan of care utilizing expertise in counseling, crisis intervention and medical-legal issues, to ensure optimization of health outcomes for clients and their families. RN will work with multidisciplinary team members to develop plan of care for clients and collaborate with RN manager/TMC Director and assist with projects as needed.

Essential Functions

• Process referrals by inputting client information as received from the fire field crews or TMC Case management team each day.
• Process client intakes by meeting with clients on the phone or in their home to gather basic information including but not limited to perceived needs, home income, health insurance information, primary care information and caseworker information. Includes home safety check and attempt to meet with any other important parties, delivery of DME, Set up and attend appointments with clients, assist clients with home moves, Facilitate and coordinate with outside agencies for home repair for safety, hoarding clean up and pest extermination. Assist clients with connections to providers.
• Assesses and responds to patient and family needs by coordinating efforts of other team members and develop treatment plans and assist with own clients and navigator clients as a resource and discusses proposed course of treatment with patients, providers, families, community stakeholders and other members of the team.
• Evaluates, documents, and addresses psychosocial, cultural, emotional, and economic needs of patients and families.
• Collaborates with the hospital care team, outpatient care team, and community agencies including city departments, code enforcement and police department as needed, to creatively resolve issues that could potentially be harmful to client or families.
• Resource outreach by creating and maintaining relationships with various agencies within the community that can provide TC-3 clients with alternatives to the 911 system to more appropriately manage each individual's particular circumstances.
• Provide case management through identifying and coordinating with community resources in the area that will likely meet your client's and family needs. These should be alternatives to the 911
  
  

system and may include ongoing case management, durable medical equipment or medical and behavioral avocation.

• Monitors clinically high risk and complicated cases and institutes necessary actions to promote quality care and appropriate interventions. Works with clients and multidisciplinary teams to identify discrepancies and barriers to health, wellness and independence towards health equity.
• Evaluate social determinates of health and develop individualized plan of care for client/family to overcome identified barriers. Evaluates clients living situations and acts as an advocate for clients.
• Measures identified barriers, records data and coordinates all efforts to improve health and wellbeing.
• Improves understanding of access points for medical care resulting in decreased use of emergency resources, decreased hospital admission, re-admission and unnecessary expenditures.
• Provides education regarding health promotion and disease prevention or exacerbation.
• Acts as navigator and entry point for marginalized community members to essential life enhancing resources.
• Works with clients experiencing behavioral health and or substance use/abuse, acting as liaison into BH/SU/SA treatment.
• Evaluates and initiates changes when indicated to ensure efficiency and maximize benefit to patient or client and organization.
• Intervenes, as needed, in emotional crises with patients and families.
• Ensures and completes documentation in the electronic record that is clear, concise, accurate and organized.
• Maintain current knowledge of policies/procedures, standard works, equipment, and supplies necessary for ensuring safe patient care.
• Receives guidance and direction from TC-3 Leadership and Fire Department Chain-of-Command in a professional and receptive manner.
• Maintains a clean, safe environment.
• Attends in-services and staff meetings then incorporates the information to improve patient care.
• Uses crisis intervention skills when appropriate.
• Interacts with patients in a professional manner.
• Facilitates communication and cooperation among various hospital and community partners involved in care of patients.
• Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
• Adheres to TMCH organizational and department-specific safety, confidentiality, values policies and standards.
• Performs related duties assigned.
  
  

Education

MINIMUM QUALIFICATIONS

• Bachelor degree in Nursing.
  
  

Experience

• Minimum two (2) years of experience of nursing in acute care setting.
• EMT, prehospital, emergency room, or case management experience preferred.
  
  

Licensure Or Certification

• Current RN licensure permitting work in the state of Arizona.
• Basic Life Support (BLS) certification required.
• Crisis Management required within three (3) months of hire.
  
  

Knowledge, Skills And Abilities

• Knowledge of basic life support, first aid, and a hospital approve non-Violent Crisis Intervention Training Program.
• Knowledge of behavioral health best practices, regulations and procedures to ensure safety of patients and staff.
• Skill in providing basic support and leisure activities for patients.
• Ability to read and interpret documents such as safety rules, treatment plans operating and maintenance instructions, and procedure manuals.
• Ability to complete routine reports and correspondence.
• Ability to actively listen and communicate clearly and concisely; encouraging open communications to achieve mutual understanding and accurately interpret others' communication or instructions to take appropriate action.
• Ability to speak effectively with patients/clients, co-workers, and other personnel.
• Ability to make wise and fair judgments based on solid facts; is open minded and understanding of values of superiors, subordinates, peers and others.
• Ability to calculate figures and compute rate, ratio, and percent, and to draw and interpret bar graphs; ability to apply basic algebraic concepts.
• Ability to define problems, identify data, establish facts, and draw valid conclusions.