The Nurse Navigator functions as a member of the multidisciplinary team and serves as an advocate and educator for patients with acute and chronic conditions. The Nurse Navigator’s primary function is to ensure the patient remains compliant to their treatment plan. Navigators achieve this goal by building relationships with patients and physicians, coordinating the plan of care, assisting with appointments, transportation needs, education, resource provision and/or representation within the multidisciplinary care environment while also working to meet program’s incentivized goals of improving the healthcare experience and reducing rates of avoidable hospitalizations and readmissions. 

Clinic Nurse Navigator reports directly to the Director of Population Health

● Will serve as a liaison between the patient and family, all physicians involved in that patient’s care, internal and external healthcare providers, support network members, and the wider healthcare community

● Comprehensively assess patient/family psychosocial and care needs

● Effectively and efficiently, track the care delivery process for each patient with the attention to detail to identify where intervention is required

● Self-direct and prioritize multiple simultaneous tasks

● Build rapport with those most in need of comprehensive medical care and assess strengths, needs, abilities and preferences

● Collaborate with the patients to build an individual plan of care based on identified patients goals with input and medical team

● Arranging services and completing linkage required based on individualized needs

● Coaching and education to increase patients level of understanding of disease progression, treatment and healthy lifestyle

● Promotes program refinement, understanding client/public needs and effectively participates in all assigned meetings

● Effectively working with high-risk, vulnerable client populations

● Ability to work with persons in crisis

● Other duties as assigned

1. Licensure/Certification:
  a) Licensed Practical Nurse or Registered Nurse
  b) Current and unencumbered license
  c) Preferred experience in case management