RN Navigator - Orthopedics

Employment Type: Full time Shift: Description: Assist with management of the Lower Joint Replacement Program with primary focus on the Comprehensive Care for Joint Replacement (CJR) Program to support better and more efficient care for beneficiaries undergoing Hip and Knee replacements. Clinical Care Coordinator Orthopedics is responsible for leading and providing direction to patient, surgeons, other interprofessional team members to aid in program success. Demonstrates leadership abilities using chain of command using the escalation process in a timely and efficient manner. * Provide leadership to patients and the Orthopedic care team. *Builds collaborative relationship with all physicians and support personnel. *Takes a global view to problem-solving. *Demonstrates diplomacy and tactfulness. *Decision making aligns with organizational and program goals. *Serves as clinical resource person *Builds and maintain relationships with post-acute care providers to support excellent patient outcomes. Quality *Reviews cases prior to surgery to identify barriers to patient success and work with patients/caregivers/inter-professional team to optimize patients pre surgery for success *Develops and uses tools appropriately to screen patients preoperatively; work with PCCs to ensure patient contact info updated including obtaining current email addresses Analyzes patient''s current clinical status, treatment plan and past medical history to identify potential gaps. *Identify, discuss, and plan measures with patients and caregivers to address gaps identified (Dietician, Smoking Cessation, Diabetic Counselling, etc.) *Enroll patients in the appropriate program to address care gaps *Identify social service & functional concerns & address gaps appropriately *Escalates appropriate cases to the LMJ Review Committee *Presents cases with recommendations to the Review Board *Participates in an A3 project annually *Ensures appropriate clinical documentation to support appropriate admission status (Inpatient vs Outpatient) and level of care identifying Least Restrictive Next Site of Care (NSOC). *Tracks NSOC, Acute/Subacute length of stay (LOS), Readmissions and Cost for all CJR patients *Assures appropriate sequencing of care/interventions for optimal results and smooth transition along hospital care and post-acute continuum. *Proactively identify and address barriers that impede the progress of care. *Accountable for organizational goals and metrics directly associated with the CJR program. Daily Operations *Maintains an accurate CJR patient census *Appropriately screen patients and identify clinical/social barriers to successful surgical intervention *Provides teaching and assist in coordinating rehabilitation for patients to prepare them for surgery and minimize complications. *Identify and agree on NSOC with patient/caregiver ahead of surgery and communicate patient care needs and NSOC to hospital care team prior to surgery. *Assist in educating patients and caregivers on wound care pre and post procedure precautions *Assist in identification of potential reasons for complications to help reduce avoidable readmissions. *Respects and maintains confidentiality of patient, staff and privileged hospital information. *Collects data when requested *Demonstrates proficiency at organizing and presenting pertinent orthopedic findings to physicians and leadership when appropriate. *Conducting Readmission Root Cause Analyses (RCA) within 48 hours of readmission in collaboration with surgeon & other members of the care team and present to Readmission Steering Committee *Reports problems, follows up on concerns or complaints of physicians and/or patients in a timely manner. *Works at maintaining a good rapport and cooperative working relationship with primary physicians, surgeons, and associates of the Orthopedic Institute. *Represents the organization in a positive professional manner. *Complies with all organizational policies regarding ethical business practices. *Initiates and follows appropriate clinical pathways and plans of care. *Works with Orthopedic & other Acute Unit ACM/SWs/APP staff to ensure all members of the care team are in alignment with patient''s goals and pre surgery agreed transition plans *Performs all other duties as assigned. *Demonstrates technical and clinical competence. Our Commitment to Diversity and Inclusion Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

Created: 2025-11-15