Description

Job Summary

The Nurse Navigator (NN) is a RN who works collaboratively with physicians, staff and other health care professionals to provide key care coordination across the health care spectrum for all patients within the hospital setting. They are a crucial member of the health care team, responsible for educating patients about their disease, prescribed treatment, acting as a clinical resource, and engaging the patient throughout their care through utilization of best practice and high quality standards across the continuum. The NN requires the ability to communicate effectively with patients, care givers, member of the healthcare team as well as outside agencies. Overall success of the NN role is measured by the results of process/outcome performance measures for the patient population cared for within each hospital department. The NN will report to the hospital leadership appropriate to each area as well as the Chief Nursing Officer. The NN will collaborate with the FHN leadership team to ensure alignment with FHN strategic goals, mission and vision. The NN will adhere to FHN PRIDE standards.

Job Responsibilities

• Develop a comprehensive patient-centered care plan based on a physical, mental, cognitive, psychosocial, functional and environmental (re)assessment and an inventory of resources and supports, congruent with patient choices and values; provided to the patient in written or electronic form; and that documents patient information, interactions and/or communication accurately in the medical record while maintaining privacy, HIPAA, fiscal accountability and patient advocacy with patient resources.
• Assist patients with transition management between and among health care providers and settings, including referrals to other clinicians, and assisting with making follow-up appointments after a visit to the emergency department prior to discharge from hospitals, skilled nursing facilities, or other health care facilities.
• Create, modify and make recommendations for the care plan and goals with the patient based on the changes in the patient’s status or re-evaluation of the situation, all while in communication with physicians, nurses, homecare providers or others as applicable in the pertinent hospital department setting.
• Promote health behaviors in all populations, identify areas of opportunity, and ensure navigation assistance with community resources to help control health care costs, such as potential ER utilization, medication compliance, and providing appropriate resources (i.e. medical, behavioral, financial, community), while also offering subjective, objective and evidence based information pertaining to the health status of the patient from the patient, healthcare team, and any relevant sources to coordinate care.
• Coach patient/families toward successful self-management of their condition/disease, incorporates motivational interviewing and teach back for education, and identifies potential risks and barriers to short and long term goals.
• Collaborates with the patient and healthcare team to integrate interventions which promote, maintain, restore health or support the end of life situations.
• Eligible for BSN Cert. Pay and PNPP program.

Qualifications

Requirements

Education: Associate Degree in Nursing is required

Required Experience: RN with 2 – 5 years prior field-related and other-job related experience.

Physical Requirements:

Populations Served:

While performing this job, the employee may care for patients in the following age groups. Neonate (< 30 days)

Infant (< 1 year)

Early Childhood (1 year and < 5 years)

Late Childhood (5 years and < 13 years)

Adolescent (13 and < 17 years)

Young Adult (17 to < 30 years)

Middle Adult (30 years to < 60 years)

Older Adult (> 60 years)

Serves patients in areas other than direct patient care