Care Transitions Nurse Navigator - Full Time - Days

Guthrie Health•Horseheads, NY

32d•$39 - $54•Hybrid

About The Position

Care Transitions RN Navigator - This is a hybrid position with expectations to work out of the Pulse Center located in Big Flats, NY! This position is day shift, Monday-Friday but may be required to do some on call over the weekends. This position is eligible for a $25,000 sign on bonus! Summary The Care Transitions Nurse Navigator is responsible for managing a patient's successful transition from hospital to home, providing disease management, care coordination, and patient triage. The Nurse Navigator will be responsible to linking mobile resources together, integrate and coordinate them to respond appropriately to patient needs. Telephonic patient triage is provided following established evidence-based protocols to assist in navigating care across the health care continuum. The Navigator is responsible for telemonitoring and patient education activities, and actively coordinates team care in a virtual setting.

Requirements

A minimum of five (5) years relevant clinical experience who demonstrates leadership and autonomy in nursing practice.
Graduate from an accredited School of Nursing.
The Care Transitions Nurse Navigator must be licensed as a Professional Registered Nurse in both New York and Pennsylvania.
The applicant must have a current license as a Professional Registered Nurse in their state of practice prior to the position's start date.
Additional state licensure must be obtained within 6 months of hire.
Patient outreach and contact will be limited to those patients living in the state of current licensure until dual licensure is obtained.
Travel for this position may be required.
The individual must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements as to his/her specific needs, and to provide the care needed as described in the appropriate policies and procedures.
It is understood that this description is not intended to be all inclusive, and that other duties may be assigned as necessary in the performance of this position.

Nice To Haves

Preferred experience in an emergency or acute care setting, chronic disease management or care transitions.
Bachelor's degree in nursing preferred.

Responsibilities

Access and navigate EMR System (Epic) to identify patients referred for a community paramedicine visit.
Provide education to the patient virtually at bedside on paramedicine visit and obtain verbal consent for the visit.
Facilitate the referral to the appropriate EMS provider for the initial post-discharge paramedicine visit.
Acts as a primary contact source for patients to escalate concerns, worsening symptoms.
Collaborate with primary care, Care Coordination staff, specialists, EMS crews, Pulse Center team to meet patient needs.
Coordinate deployment of home-based services as appropriate (home health, paramedicine, urgent/emergent EMS response) with appropriate Pulse Center staff and agencies
Schedules follow up appointments for the patient as needed.
Act as a point of contact for patients enrolled in the Chronic Care Management program.
Triage patient questions/concerns, and coordinate care as appropriate
Provide feedback to the appropriate care coordination staff members regarding patient interactions.