Assists and provides support to high risk patients who require
support to address barriers to improved care and their overall
health outcomes and empower patients to become active participants
in their own care. Assists with coordination of care between
healthcare providers to ensure that patients receive the right care
at the right place and the right time.
Work in collaboration with members of the patients care team and
communicate effectively. Candidate must be able to thrive in a
moderately paced, urgent need, complex, health care environment,
where the Nurse Navigator works as a key, valued member of the
Patients with moderate and high risk for poor outcomes /
inefficient care require additional assistance to manage their
chronic conditions. The nurse navigator will address any gaps in
care that are identified, alongside the primary care physician and
specialists to improve patient health outcomes, quality of life and
improve the patient care experience. This is in addition to
coordinating medical appointments; addressing patients barriers to
medication regimen adherence, reminding patients of appointments,
coordinating nonclinical services (such as transportation home
health aide). Maintain appropriate documentation of patient
contact, referrals made, and services provided. Must always be
time-efficient, organized, professional and compliant with HIPAA
rules and regulations.
Duties will include:
Demonstrates proficient computer skills and is able to function
within the electronic medical record as well as other computer
Supports practice manager with the implementation of key
processes of patient centered initiatives in the practice.
Facilitates staff training and education on the tenets of
patient centered care, chronic disease management and
Empower the patient/ family to collaborate with the healthcare
providers to create and maintain a patient-centered care plan.
Will work in collaboration with the primary care physician to
notify the office of the patient's disposition and any available
Reviews documentation provided from insurance carrier, medical
record, care plan, records from hospital or other referral sources
to determine patient needs for navigation services and discuss a
patient specific plan of action.
Facilitate the scheduling of follow up appointments during
transitions of care.
Will contact high-risk patients after the office follow up visit
and review their care plan and follow up visit instructions through
teach-back techniques. Help facilitate any orders for tests/
procedures / referrals or subsequent follow up appointments.
Answers general questions about tests, procedures, getting to
offices, labs, hospitals. Help patients to formulate questions to
ask their healthcare provider and to be empowered to participate in
shared decision making.
Provides referrals to other local agencies, as appropriate, for
services such as transportation etc.
Work closely with the PCPs office staff and attributed patients
to close gaps in care.
Documents all client interactions in electronic database with
accurate notes indicating interactions with patients, specialists,
care providers and hospital staff ancillary service providers.
Works collaboratively as a team with other Nurse Navigators and
office staff to ensure that each patient receives comprehensive
Other related duties or special projects related to quality
activities or initiatives as assigned by supervisor.
*Education*: Registered Nurse or Licensed Practical Nurse
*Experience*: At least 3 years minimum experience in an
outpatient healthcare setting
Job Type: Full-time
Powered by JazzHR