Nurse Navigator

Bayview Physicians Group•Chesapeake, VA

About The Position

The Nurse Navigator plays a key role in supporting high-risk patients by identifying and addressing barriers to care, promoting adherence to treatment plans, and empowering patients to take an active role in their health. This position coordinates care across the healthcare continuum—ensuring patients receive the right care, at the right time, in the right setting. This role requires collaboration with physicians, care team members, patients, and community partners to ensure seamless care delivery. The ideal candidate thrives in a moderately paced, complex care environment and is passionate about improving health outcomes and the overall patient experience.

Requirements

Registered Nurse (RN) or Licensed Practical Nurse (LPN)
Minimum of 3 years in an outpatient healthcare setting
Strong understanding of chronic disease management and patient education principles
Excellent communication and organizational skills
Proficiency with electronic medical records and basic computer applications
Knowledge of HIPAA and commitment to maintaining patient confidentiality
Ability to work independently and as part of a multidisciplinary team

Responsibilities

Coordinate care for moderate- to high-risk patients, including scheduling appointments, arranging referrals, and addressing barriers such as transportation or medication adherence.
Serve as a liaison between patients, primary care providers, specialists, and support services.
Support care plan development and execution, ensuring patient understanding through techniques such as teach-back.
Review and interpret medical documentation and insurance data to assess patient needs and formulate a care navigation plan.
Conduct post-visit and post-discharge outreach to reinforce care plans and ensure follow-through.
Educate patients on chronic disease management, navigating the healthcare system, and preparing for appointments.
Refer patients to local community resources and services, as needed.
Accurately document all patient interactions, care coordination efforts, and outcomes in the electronic medical record system.
Work collaboratively with other nurse navigators and clinical staff to provide seamless, patient-centered care.
Support quality improvement initiatives and participate in staff training around patient-centered and chronic care models.
Perform other duties or special projects as assigned.