The Clinical Nurse Navigator will coordinate and manage the care of surgical patients to ensure continuity of care delivered with compassion, excellence, and reliability by serving as a single point of contact for referring physicians, patients, and caregivers. Navigator will provide resources, education and assistance with accessing clinical and supportive care services offered within the Munson Health Care system and surrounding communities. The Navigator will facilitate patient appointments including those made for diagnostic services or clearances needed and be a resource for patients before and after surgery/delivery. Reports to Director of Care Coordination.
Must possess a current RN license to practice nursing in the State of Michigan. Bachelor of Science degree in nursing preferred. Previous experience in Pre-Admission Testing, Case Management or clinical experience relevant to patient population being served is necessary. Individual must be detail oriented, have computer application experience as well as excellent written and oral communication skills. Position requires problem solving, decision making, and critical thinking skills.
Skills, Talents and Abilities
Must be able to work in a self-directed environment and possess the ability to collaborate with a variety of providers and other individuals. Must have ability to be non-judgmental and work with those holding diverse opinions, religions and cultural values. Ability to implement professional and community based education programs is a must. Multi-tasking and organizational skills are mandatory.
1. Provide patient information about Navigation services.
2. Provide appropriate resources in a timely manner to meet specific patients' needs.
3. Provide patient education and develop patient education tools.
4. Consider language, culture, age and special needs in choosing referral options.
5. Serve as a liaison between patients, staff, and services.
6. Explain the referral process with patients and facilitate arrangements for appointments as needed.
7. Form relationships with patients and key customers. Give contact information (business cards, etc.) to staff, community resources, and patients.
8. Schedule informational meeting with patient to provide specific education regarding what to expect before and after procedure, medical clearances, PAT process, medication and diet restrictions, inpatient stay, behavioral health and other community resources available for after surgery/delivery.
9. Document education and referral information in patient's chart.
10. Assist with/communicate special arrangements or needs with OR and hospital staff.
11. Patient Advocate- Guide patients through and around barriers in the healthcare system.
12. Once a patient is in the Navigation system, it is the Nurse Navigator's responsibility to follow the patient through the care continuum.
Administration and Communication
1. Receives direction from and works with the providers, Office Managers, and Clinical Manager to plan, implement and evaluate the appropriate services.
2. Collaborates with providers to identify, track, and report outcomes of services provided.
3. Develops educational plan for providers, staff, and patients participating in Navigation services.
4. Accurately documents observations, interventions and evaluations pertaining to care management. This will include but is not limited to: assessments, medication information, treatments, and coordination of services, patient progression toward goals, and contacts with physicians, agency and community providers.
5. Takes appropriate steps to assure timely submission of patient data for inclusion in the client record (by timely electronic transmission of data, or when appropriate by fax or mail.)
6. Effectively and efficiently prioritizes visit content, patient goals and plans based on patient's capabilities, condition, preferences (when possible), physician orders and available resources.
7. Makes appropriate referrals for evaluation/care to other disciplines and services, and coordinates care with others to ensure needed care is provided.
8. Reports changes in patient condition as appropriate and in a timely manner to the patient's physician, anesthesia, and surgeon as necessary and obtains orders for changes in the plan of treatment to respond to the patient's condition.
9. Participates in quality improvement processes including peer review as directed.
10. Participates with call backs and quality assurance after care. Provides a single point of contact for questions and follow up appointments.
Professional Development and Delegation
1. Demonstrates self-education as evident by:
a) Identifies and documents education needs
b) corrects the knowledge deficit through multiple learning activities
c) mentoring and role-modeling
2. Assures that standards and practices reflect current standards and best practice within area of expertise.
3. Acts independently and responsibly to perform duties on a consistent basis and in a timely manner.
4. Demonstrates further professional growth through sharing knowledge with others (e.g. presentations regarding nurse navigator role, community services, acting as a preceptor to other employees).
5. When acting as nurse navigator, takes lead responsibility for care plan and case management, assuring appropriate care, supplies, and follow through.
6. Delegates tasks to appropriate personnel as indicated by skill level and professional standing.
7. Ensures that services are provided in a manner that supports continuous quality improvement, customer-oriented focus and quality of client care outcomes.