Clinical Services Navigator RN

UVA Health•Gainesville, VA

About The Position

The Clinical Services Navigator facilitates care coordination from acute care to the ambulatory setting and serves as a valued member of the healthcare team. The role collaborates with physicians, case managers, and other healthcare professionals to coordinate care and follow-up appointments, and consults with case managers on medically or psychosocially complex cases. The navigator serves as a care-coordination resource and maintains current knowledge of community resources, post-acute care, and ambulatory options. The position supports patients through surgical care pathways by providing education about ERAS protocols, recovery expectations, and discharge planning; reviewing records for patient needs and barriers; maintaining patient contact before and after surgery; and coordinating services and follow-up. The navigator works with interdisciplinary teams to monitor pathway adherence and patient outcomes, promote quality and safety, and support process improvement. This is a Monday–Friday position with no weekends or holidays. Travel to the Culpeper location is required two days per week. The role may also require travel between campus buildings, remote facilities, and out of town as needed, and may involve on-call responsibilities as directed. The base compensation range is $37.99–$54.63 per hour.

Requirements

RN licensure required.
Demonstrated effective communication skills for patient education and for discussing case management, financial, and clinical issues with case managers, physicians, outside agencies and facilities, nurses, and other community healthcare professionals.
Ability to work autonomously, take initiative, and make independent decisions.
Organized, with effective time-management skills.
Detail-oriented, with the ability to facilitate change and achieve positive results.
Proficient with computer and web-based tools.
Ability to meet the physical demands of constant standing, frequent walking, and bending or stooping.
Proficient communicative, auditory, and visual skills; attention to detail and ability to write legibly.
Ability to lift, push, or pull up to 100 pounds; Safe Handling Equipment must be used for weights over 35 pounds.

Nice To Haves

Bachelor’s degree preferred.
Two years of experience preferred.
Five years of clinical experience with knowledge in the care of a disease-specific population preferred.
Certification in a specialized area preferred.
National specialty certification required, or to be obtained within two years, if applicable to the position.

Responsibilities

Facilitate care coordination from acute care to the ambulatory setting.
Coordinate care and follow-up appointments with physicians, case managers, and other healthcare team members.
Collaborate with case managers on medically and/or psychosocially complex cases.
Provide patient and family education regarding the surgical pathway, ERAS protocols, recovery expectations, and discharge planning.
Reinforce health promotion, mobility, and illness prevention strategies in collaboration with the care team.
Review patient records to identify needs, barriers, and opportunities for support across the care continuum.
Recommend and connect patients and families with appropriate community resources and support services.
Maintain ongoing pre-operative and post-operative phone contact with patients to support understanding, readiness, and continuity of care.
Collaborate with interdisciplinary teams to support quality outcomes, including reduced length of stay, readmission prevention, infection reduction, and same-day discharge targets.
Monitor patient outcomes and pathway adherence to identify trends and opportunities for improvement.
Apply safety and infection-prevention principles in patient interactions.
Participate in quality initiatives, audits, and process-improvement activities.
Serve as a central point of contact for patients and promote consistent messaging across the care team.
Collaborate with physicians, nursing, PT/OT, anesthesia, and case management to coordinate care and discharge planning.
Participate in interdisciplinary rounds, staff meetings, and care conferences.
Communicate process-improvement opportunities and feedback from staff and patients to leadership.
Assess patient readiness for surgery and recovery by reviewing records, identifying barriers, and escalating concerns appropriately.
Track and document patient progress across the continuum to ensure alignment with clinical pathways and program metrics.
Support transitions of care by scheduling follow-up appointments, coordinating services, and ensuring patients understand next steps.
Maintain current knowledge of hospital services, community resources, post-acute care, and ambulatory options.
Perform additional duties as assigned.