Functioning as part of a multidisciplinary team in an inpatient and outpatient setting, the Population Health Nurse Navigator acts as a patient advocate, program expert, educator, and care coordinator for the patient population with Social Determinants to Healthcare (SDOH) factors and those transitioning across the continuum of care. Responsible for assessing needs, coordinating conversations, customizing plans and driving tangible change within the population. Act as an expert guide to the care team and community organizations on SDOH factors and best practice ways to improve health of this population.

　　Primary Accountabilities1. Establish and maintain functional systems to identify and track for the Health First Health Plans (HFHP) member population with Social Determinants of Healthcare (SDOH) factors impacting health outcomes.2. Serve as an expert to providers and team members in real time to ensure all gaps in care are identified, documented and closed as quickly as possible.3. Educate and assist the identified HFHP members to obtain the care that is needed and support with appropriate HC navigation.

　　Leverage technology and collaborative partnerships to drive transformation and build better efficiencies.

　　Provide in-person, phone or written, consultation and support to members and their families.

　　Track status (?), order completion and follow up. Monitor patient compliance with patient treatment plan.

　　Collect and report data from HFHP members on health care barriers, medication concerns, prior treatments, and other aspects of health care .

　　Participate in performance improvement activities, data collection and continuous quality improvement (CQI) activities.

　　Oversee the planning, scheduling, and implementation of day-to-day clinical activities and procedures for navigated members.

　　10.Assist members with referrals to outside resources and care coordination as needed.11.Design or participates in the creation of health education materials.

　　MINIMUM QUALIFICATIONS

　　· Education:Bachelor’s Degree in Nursing

　　· Licensure:Current Registered Nurse with licensure in the State of Florida

　　· Certification:Current BLS certification

　　· Work Experience:3 years nursing experience

　　· Work Experience in lieu of Education:None

　　· Knowledge/Skills/Abilities:

　　o High level of emotional intelligence / ability to effectively relate to others

　　o Self-directed worker capable of managing multiple tasks

　　o Effective verbal and written communicator

　　o Highly organized with own work habits and able to organize others

　　o Computer and technology savvy / able to use Microsoft Office Suite (Excel, Word)

　　o Able to effectively manage conflict and drive desired outcomes

　　o Proficient educator who is able to successfully teach individuals ranging from those with limited verbal and literacy ability to academics

　　o Flexible and accommodating when needs or requirements change

　　o Documents to identified standards

　　Job: *Medical Management

　　Organization: *HF Administrative Plan Inc

　　Title: Population Health Nurse Navigator - Medical Management

　　Location: Florida - Brevard County

　　Requisition ID: 070595