Acute Care RN Navigator (Stroke and High Risk Patients) - Case Management

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Job Profile Summary This role focuses on providing professional and nonprofessional nursing care services in accordance with physician orders. In addition, this role focuses on performing the following Nurse Navigator duties: Focuses on the patient's needs and helps guide the patient through the healthcare system and works to overcome obstacles that are in the way of the patient receiving the care and treatment they require. A professional individual contributor role that may direct the work of other lower level professionals or manage processes and programs. The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education. A senior level role that requires advanced knowledge of job area typically obtained through advanced education and work experience. Typically responsible for: managing projects / processes, working independently with limited supervision, coaching and reviewing the work of lower level professionals, resolving difficult and sometimes complex problems. Job Overview The RN Navigator serves as a liaison between patients, community resources, and providers and supports a smooth transition from hospital to home with a goal of eliminating and/or reducing readmissions, patient satisfaction, and continuity of care across the continuum. Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned. 1. Assesses and facilitates coordination of multidisciplinary care across the care continuum. 2. Provides communication, advocacy, and education in a culturally competent manner. 3. Triages new patient referrals to ensue timely access to care. 4. Conducts post discharge follow up phone calls and serves as a liaison and patient advocate in navigating the healthcare system. 5. Provides patient education and supports utilizing knowledge of adult learning competencies and education resources to support complete, connected, and comprehensive care. 6. Collects and reports data from patient on barriers, hospital experience, health care, medications, prior treatments, etc. 7. Collaborates with multidisciplinary care team and expedites sequence of patient's care. 8. Serves as a liaison between patient and providers/clinicians to address patient's needs. 9. Assesses patient's needs and ensures such needs are integrated into patient's care plan. 10. Encourages and empowers patients to actively participate in decision making about their treatment and care. Hours: 40 hours/week, Day Shift Education and Qualifications: Massachusetts RN Licensure. Current Basic Life Support (BLS) Certification. Bachelor of Science in Nursing (BSN) preferred ASN required

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