RN Primary Care Navigator

Job Description Summary:

Are you a compassionate and experienced Registered Nurse (RN) looking to make a meaningful impact in patient care

Our team in Kalispell MT has an opening for a parttime Primary Care Navigator to provide vital care coordination and support for patients navigating complex healthcare needs. This role focuses on enrolling and managing patients in the Chronic Care Management (CCM) Program assisting with resources coordinating medical care and ensuring seamless communication between providers.

As an RN Primary Care Navigator you will help patientsranging from pediatrics to the elderlyconnect with essential healthcare services. Your role will focus on chronic disease management patient education care coordination and support over the phone. You will be a crucial liaison between patients families and healthcare teams ensuring smooth transitions and continuity of care.

If youre an organized selfdriven professional who thrives in a collaborative environment and excels in phonebased patient support wed love to hear from you!

Key Responsibilities:

• Enroll patients in the CCM Program and educate them on program benefits.

• Outreach to patients that may need care navigation services.

• Provide patient education on chronic disease management medication adherence and treatment plans.

• Coordinate care across multiple settings such as primary care specialty services inpatient and outpatient settings.

• Facilitate timely scheduling of appointments referrals diagnostic testing and procedures

• Assist patients in accessing resources for housing care assistance and placement services.

• Engage with primary care and specialty providers to facilitate communication and optimize patient outcomes.

• Track patient progress and provide follow up as needed to ensure effective care management.

What Were Looking For:

• Strong phone communication skills

• Selfstarter organized and detailoriented with excellent followup skills.

• Team player who collaborates well across disciplines and works independently when needed.

• Caring and compassionate demeanor with a positive attitude and commitment to patientcentered care.

• Experienced RN with history of managing chronic conditions is highly preferred.

Why Join Us

• Parttime schedule: Work three days a week no holidays no evenings or weekends!

• MissionDriven Work: Be part of a healthcare team that prioritizes quality compassionate care for all.

• Supportive & Collaborative Environment: Work with a dedicated team that values trust teamwork and excellence.

• Opportunities for Growth: Expand your skills in care coordination chronic disease management and patient advocacy.

• Competitive Compensation & Benefits: Matching 401(k) & Fitness Center membership discount!

Qualifications:

• Current Montana RN license or a multi state compact license with authorization to practice nursing within the state of Montana; required. Bachelors Degree in Nursing preferred.

• BLS certification required.

• Possess and maintain computer skills to include working knowledge of Word Outlook Excel PowerPoint Access and ability to learn other software as needed. Knowledge of electronic health records preferred.

• Must function with a high degree of autonomy communication and interpersonal skill. Must understand the health care continuum and have the ability to solve complex problems.

• Demonstrated ability to work collaboratively with multidisciplinary medical home care teams. Knowledge of professional practice standards regulatory requirements and systems operations required.

• Nursing experience in a variety of care settings (Outpatient Clinic SNF Home Health and Acute Care) preferred. Knowledge of Valuebased payment models and the Medical Home care model preferred.

• Ability to evaluate clinical outcomes across a variety of primary care settings and familiarity with diabetes and lipid management including dietary assessment preferred.

• Excellent organizational skills detailoriented a selfstarter possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.

• Commitment to working in a team environment and maintaining confidentiality as needed.

• Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.

• Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact professionalism and diplomacy.

Job Specific Duties:

• Assesses patient needs upon initial encounter and periodically throughout navigation. Matches unmet needs with appropriate services referrals and support services such as dietitians providers social work pharmacy and financial services. Acts as a liaison between the patients families caregivers and the providers to optimize patient outcomes.

• Identifies high risk patients who would benefit from chronic care management and works collaboratively with the primary care provider patient and family to develop an individualized patientcentered plan of care.

• Participates in coordination of the plan of care with the multidisciplinary team promoting timely followup on treatment. Facilitates timely scheduling of appointments referrals diagnostic testing and procedures to expedite the plan of care and to promote continuity and quality care.

• Utilizes appropriate assessment tools (e.g. PHQ2/9 mini cog pain scale etc. to promote a consistent holistic plan of care. Provides psychosocial support to and facilitates appropriate referrals for patients families and caregivers especially during periods of high emotional stress and anxiety.

• Provides and reinforces education to patients families and caregivers about chronic disease process discharge teaching/instructions new diagnosis and medications.

• Builds therapeutic and trusting relationships with patients families and caregivers through effective communication and listening skills. Utilizes motivational interviewing techniques to assist patients in meeting goals and managing chronic disease.

• Facilitates communication among members of the multidisciplinary primary care team to prevent fragmented or delayed care that could adversely affect patient outcomes.

• Supports a smooth transition of care for patients from one level of care to another. Provides acute care skilled nursing facility and emergency department (ED) follow up.

• Participates in the tracking of metrics and patient outcomes in collaboration with administration to document and evaluate outcomes of the navigation program. Focuses on prevention measures consistent with established guidelines and care process models and works toward continuously improving quality metrics and closing care gaps.

• Collaborates with the care navigation team to develop and improve workflows and protocols for primary care that ensure hospital ED and community resource followup.

• Exhibits effective communication with peers members of the multidisciplinary healthcare team and community organizations and resources.

• Works collaboratively with fellow members of the Care Navigation team providers and integrated multidisciplinary team members.

• The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge skills and abilities required for the job. Not all of the duties may be assigned to a position.

Maintains regular and consistent attendance as scheduled by department leadership.

Logan Health takes great pride in offering its employees a comprehensive benefits package that includes:

• Health Dental and Vison insurance

• 401(k) with generous matching

• Employerprovided life insurance

• Voluntary life and disability insurance options

• Critical Illness and Voluntary Accident options

• Employee assistance program

• Free parking

• Paid time off Holiday pay and Illness bank

• Employee referral program

• Tuition Reimbursement Program

• Employee Wellness Program that includes wellness coaching classes wellness incentives and more

• Logan Health Fitness Center Waived registration fee and 1/2 off monthly membership dues

Shift:

Schedule: Parttime 24 hours per week. Hours will be between MondayFriday. No holidays no weekends.

Logan Health operates 24 hours per day seven days per week. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.

Notice of PreEmployment Screening Requirements

If you receive a job offer please note all offers are contingent upon passing a preemployment screening which includes:

• Criminal background check

• Reference checks

• Drug Screening

• Health and Immunizations Screening

• Physical Demand Review/Screening

Equal Opportunity Employer

Logan Health is an Equal Opportunity Employer (EOE/AA/MF/Vet/Disability). We encourage all qualified individuals to apply for employment. We do not discriminate against any applicant or employee based on protected veteran status race color gender sexual orientation religion national origin age disability or any other basis protected by applicable law. If you require accommodation to complete the application testing or interview process please notify Human Resources.