Nurse Navigator - Outpatient Oncology

Trinity Health

5d•Onsite

About The Position

The Nurse Navigator is accountable for facilitation and management of care coordination across the healthcare continuum for a designated population. Serves the advanced nursing needs of stroke patients across the continuum by providing direction for patient care and individualized education for patients and family. Acts as a patient advocate and link to community resources. Provides post-discharge care coordination. Provides continuity of care by ensuring smooth transitions between care settings. Develops a relationship with the patient and their multidisciplinary team to facilitate and/or navigate through subsequent treatment and follow-up to reflect continuity of care. Performs post-discharge follow-up on identified patient population at defined intervals. Supports the patient and family by providing education, addressing psychosocial needs, advocating, providing continuity of care, and identifying barriers to care. Navigates patients and family members throughout the diagnosis, treatment, and follow-up of a patient throughout the continuum of care. Attends diseasespecific support group and assists program coordinator with facilitation of community-based initiatives. Participates in multidisciplinary rounds and supports nursing staff in development of individualized, evidence-based outcome oriented, safe and timely practices

Requirements

Accountable for facilitation and management of care coordination across the healthcare continuum for a designated population.
Serves the advanced nursing needs of stroke patients across the continuum by providing direction for patient care and individualized education for patients and family.
Acts as a patient advocate and link to community resources.
Provides post-discharge care coordination.
Provides continuity of care by ensuring smooth transitions between care settings.
Develops a relationship with the patient and their multidisciplinary team to facilitate and/or navigate through subsequent treatment and follow-up to reflect continuity of care.
Performs post-discharge follow-up on identified patient population at defined intervals.
Supports the patient and family by providing education, addressing psychosocial needs, advocating, providing continuity of care, and identifying barriers to care.
Navigates patients and family members throughout the diagnosis, treatment, and follow-up of a patient throughout the continuum of care.
Attends diseasespecific support group and assists program coordinator with facilitation of community-based initiatives.
Participates in multidisciplinary rounds and supports nursing staff in development of individualized, evidence-based outcome oriented, safe and timely practices.

Responsibilities

Facilitate and manage care coordination across the healthcare continuum for a designated population.
Serve the advanced nursing needs of stroke patients across the continuum by providing direction for patient care and individualized education for patients and family.
Act as a patient advocate and link to community resources.
Provide post-discharge care coordination.
Ensure smooth transitions between care settings for continuity of care.
Develop relationships with patients and their multidisciplinary teams to facilitate and navigate treatment and follow-up.
Perform post-discharge follow-up on identified patient populations at defined intervals.
Support patients and families by providing education, addressing psychosocial needs, advocating, providing continuity of care, and identifying barriers to care.
Navigate patients and family members throughout the diagnosis, treatment, and follow-up of a patient throughout the continuum of care.
Attend disease-specific support groups and assist program coordinators with facilitation of community-based initiatives.
Participate in multidisciplinary rounds.
Support nursing staff in the development of individualized, evidence-based, outcome-oriented, safe, and timely practices.