JOB PURPOSE:
Health Care Navigators provides services that include connecting Veterans to VA health care benefits or community health care services where Veterans are not eligible for VA care. Health care navigator's s provide case management and care coordination, health education, interdisciplinary collaboration, coordination, and consultation, and administrative duties. Healthcare Navigators work closely with the Veteran's primary care provider and members of the Veteran's assigned interdisciplinary treatment team.
The health care navigator possesses excellent judgment and has at least two years of experience in a healthcare or social services area of practice. The health care navigator will act as a liaison between the Veteran Supportive Services Program and VA or community medical clinic and works with a population of Veterans with complex needs who require assistance accessing health care services or adhering to health care plans.
The health care navigator works closely with the Veteran's assigned multidisciplinary team, including medical, nursing, and administrative specialists, and case management personnel. The health care navigator works within this team to provide timely, appropriate, Veteran centered care equitably. The health care navigator works collaboratively with the team and the Veteran to identify and address systems challenges for enhanced care coordination as needed.
ESSENTIAL JOB RESPONSIBILITIES:
A. Non-Clinical Assessment
Conducts assessments of the Veteran in collaboration with the interdisciplinary treatment team, the Veteran, family members, and significant others. The purpose of the assessment is to understand the Veteran's situation, potential barriers to care, the causes, and the impact of such barriers on the Veteran's ability to access and maintain health care services. The assessment should highlight the Veteran's strengths, limitations, risk factors, and internal/external supports and service needs to optimize the Veteran's ability to access and maintain health care services. The initial assessment will be completed as specified by the policy. An assessment may be accomplished through virtual technology.
B. Health Care Team and Veteran Communication
The Health Care Navigator works closely with Veterans to assist them in communicating their preferences in care and personal health-related goals to facilitate shared decision making of the Veteran's care. The Health Care Navigator serves as a resource for education and support for Veterans and families and helps identify appropriate and credible resources and support tailored to the needs and desires of the Veteran.
C. Specialized Case Management and Care Coordination
The Health Care Navigator provides comprehensive case management and care coordination across episodes of care-the Health Care Navigator acts as a health coach by proactively supporting the Veteran to optimize treatment interventions and outcomes.
The health care navigator modifies services to meet the needs of Veterans best and coordinates services with other organizations and programs to assure such services are complementary and comprehensive; directs activities to maximize effectiveness, efficiency, and continuity of care for Veterans; provides case management services to Veterans serves as the liaison to VA and community health care programs, and represents the program in contacts with other agencies and the public.
The Health Care Navigator helps coordinate supportive and additional services with the Veteran. The Health Care Navigator ensures and links Veterans and caregivers to supportive services, which include, but are not limited to, housing, financial benefits, transportation.
The Health Care Navigator serves as the subject matter expert on community resources related to the needs of the Veteran. The health care navigator collaborates with other providers in the ongoing reassessment of the Veteran's health care needs. The health care navigator is responsible for educating the Veteran and caregiver of the available services and assisting them in establishing the appropriate referrals based on the Veteran's preference.
The Health Care Navigator will determine the needs, strengths, limitations, and preferences of each Veteran and will engage in problem solving to identify and reduce barriers to care. The health care navigator will educate the Veteran and family on the available options for acquiring knowledge and skills for managing health and wellness.
The Health Care Navigator coordinates referrals to VA, community health clinics, and other programs needed to ensure access to health care. The Health Care Navigator follows the care plan to facilitate adherence, and collaborates with community providers to maximize the use of VA and community resources.,
The Health Care Navigator acts as an advocate for the client, integrating the Veteran's cultural values into their care plan. The health care navigator assists the Veteran in identifying methods to monitor progress toward meeting health goals and provides ongoing follow up.
D. Health Education
The Health Care Navigator assists in identifying the Veteran and family's health education needs and provides education services and materials that match the health literacy level of the Veteran. The health care navigator provides ongoing education support as needed to the Veteran and family member. The Health Care Navigator assists in identifying VA and community resources to prevent disease and promote self-care. For specialized health education outside of the Health Care Navigator's scope of practice, the health care navigator will refer to Veterans and families to the appropriate interdisciplinary team member for identified health education needs.
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