Nurse Navigator - MGH

Mass General Brigham•Boston, MA

1d•$42 - $108•Hybrid

About The Position

The RN Navigator supports the Outpatient Palliative Care Clinic, working with patients who have serious or complex illnesses. The role collaborates with referring clinicians to obtain clinical and psychosocial information needed to triage and prioritize referrals according to symptom burden, illness acuity, goals-of-care needs, and patient and family support requirements. The navigator helps ensure patients with the most urgent palliative care needs receive timely intervention. The RN Navigator coordinates communication and care planning among interdisciplinary teams and specialty services to promote continuity and alignment across the continuum of care. The role educates clinicians and staff about pathway criteria, supports appropriate entry into designated programs, and monitors patient progression to ensure timely placement into the next appropriate level of care or disposition setting. In collaboration with clinical teams, the navigator gathers relevant clinical and social information to identify appropriate service lines, levels of care, and care settings within the health system. The position coordinates patients’ complex care needs and serves as a primary contact for service access, diagnostics, treatment activities, schedules, patient and family education, and multidisciplinary collaboration. It helps develop individualized care plans, reports pertinent observations to appropriate team members, coordinates discharge planning, resolves patient needs through multidisciplinary strategies, and educates patients on navigating the health system. This is a 12-hour-per-week, hybrid position with a day shift.

Requirements

Bachelor’s degree in Nursing required; experience cannot be accepted in lieu of a degree.
Massachusetts Registered Nurse license required.
At least 2–3 years of experience in an acute care setting, provider practice, community-based role, or discharge/transitional planning background required.
Minimum of 3–5 years of nursing experience, preferably in outpatient care settings.
Demonstrated ability to manage complex patient needs, prioritize referrals, and coordinate care across interdisciplinary teams.
Excellent communication, collaboration, and organizational skills.
Strong attention to detail and organization.
Strong cultural awareness competencies.
Proficiency in Microsoft Office.
Ability to adapt to change and welcome new approaches when circumstances demand it.

Nice To Haves

Experience in palliative care, oncology, geriatrics, emergency medicine, critical care, or other complex care populations.
Prior experience in nurse navigation, care coordination, case management, or transitions of care.
Experience facilitating goals-of-care discussions, discharge planning, and resource coordination.
Basic Life Support (BLS) certification from various issuers.

Responsibilities

Collaborate with referring clinicians to gather clinical and psychosocial information and triage and prioritize referrals.
Prioritize patients based on symptom burden, illness acuity, goals-of-care needs, and patient and family support requirements.
Coordinate communication and care planning among interdisciplinary teams and specialty services.
Educate clinicians and staff on pathway criteria and support appropriate patient entry into designated programs.
Monitor patient progression and facilitate timely placement into the next appropriate level of care or disposition setting.
Gather clinical and social information to determine appropriate service lines, levels of care, and care settings.
Coordinate patients’ access to services, diagnostics, treatment activities, schedules, education, and multidisciplinary support.
Help create tailored health care plans with the interdisciplinary team and develop individualized service plans with the physician.
Report pertinent patient observations and reactions to appropriate team members.
Assess and coordinate patients’ discharge planning needs with the health care team.
Resolve patient problems and needs using multidisciplinary team strategies.
Educate patients on how to navigate the health system.