Nurse Care Navigator
Job Description
PURPOSE AND SCOPE:
Responsible for coordination and management of evaluation of kidney transplant patients in the pretransplant phase. TECN will work in collaboration with their TECN Scheduler to schedule, confirm and execute testing. TECN will review results of testing (see responsibilities) and compile all testing once complete to submit to transplant center. TECN will review all testing and elevate abnormal testing to designated Transplant Center physician. TECN will also collaborate with the Transplant Center team to accomplish pre transplant evaluation where appropriate. TECN will attend meetings with Transplant Center when needed and present patients at selection conference for decisioning on candidacy.
PRINCIPAL DUTIES & RESPONSIBILITIES
Clinical Review & Referral Management
Review incoming referrals to ensure they meet Transplant Center Evaluation Guidelines
Request and place orders for referral testing per protocol for acceptable candidates
Consent patients and secure consent for transplant evaluation per Transplant Center Protocol
Provide CMS transplant education per Transplant Center Policy
Health Maintenance Screening
Assist patients in completing health maintenance screening tests not on the standard UNOS-required list
Schedule health screening tests with hospital services and external partners
Identify local partners (e.g., radiology centers, cardiology clinics) to perform necessary testing
Assist patients in obtaining dental care as needed per Transplant Center policy
Develop clear algorithms for special-case scenarios (e.g., commercially insured patients requiring testing at the parent hospital)
Results Review & Anomaly Management
Review results and discuss abnormal findings with the designated Transplant Center physician or designee
Maintain a real-time tracking system for test completion, results collection, and anomaly review
Maintain a clear communication pathway with the Transplant Center MD for escalating abnormal results
Coordinate communication of abnormal results to patients per pre-agreed procedures
Track and follow up on missing or incomplete tests
Guide management of patients who repeatedly miss scheduled appointments
Scheduling & Patient Coordination
Confirm patient intent and attendance with the dialysis clinic social worker (MSW)
Communicate with the FKC MSW regarding patients who are difficult or impossible to schedule
Escalate scheduling barriers to the attending nephrologist to assess candidacy or psychosocial obstacles
Billing & Reimbursement
Coordinate billing and reimbursement for testing with the Transplant Center Financial Coordinator
Ensure testing is billed through the Transplant Center and not directly to the patient
Distinguish initial screening testing (billable to transplant center) from follow-up testing (billable to patient insurance)
Participate in periodic audit trails of billing documentation
Stakeholder Relations & Reporting
Arrange lobby/practice days with Transplant Center personnel as appropriate
Coordinate joint population-level reviews between practices, clinics, and transplant centers
Solicit feedback from patients, referring physicians, and transplant center staff on TCN operations
Provide continuous updates to Operations Management regarding the clinical posture of assigned centers
Perform other related duties as assigned
PHYSICAL DEMANDS & WORKING CONDITIONS
The physical demands and work environment described here are representative of those encountered while performing the essential functions of this role. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Remote/work-from-home position
Day-to-day work involves desk and computer work, with interaction with patients, facility staff, and physicians
Travel between assigned centers required; travel to organizational meetings may be required
SUPERVISION
This position has no direct supervisory responsibilities.
EDUCATION & CREDENTIALS
Graduate of an accredited School of Nursing; RN BSN required — advanced degree preferred
Current appropriate state licensure
One multistate license with the ability to practice in all compact states
EXPERIENCE & SKILLS
Minimum 5 years of experience in pre-transplant intake, patient education, ICU, or similar clinical setting
Solid understanding of the relationship between healthcare providers and regulatory agencies
Ability to analyze complex issues and propose alternative solutions
Experience in quality management, risk management, case management, and infection control
Excellent verbal and written communication and interpersonal skills
Exemplary customer service orientation
Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint); medical database software required
Proficiency with EPIC preferred
Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.