Nurse Navigator - MGH

Mass General Brigham•Boston, MA

10d•Hybrid

About The Position

The RN Navigator supports the Outpatient Palliative Care Clinic and patients with serious or complex illnesses. The role coordinates complex care needs and serves as a primary patient contact for service access, diagnostics, treatment activities, scheduling, patient and family education, and multidisciplinary collaboration. The RN Navigator works with referring clinicians to gather clinical and psychosocial information and triage referrals according to symptom burden, illness acuity, goals-of-care needs, and patient and family support requirements. The position facilitates communication and coordination among interdisciplinary teams and specialty services to support continuity and alignment of care plans. It educates clinicians and staff on pathway criteria, supports appropriate entry into designated programs, and monitors patients’ progression through the continuum of care. In collaboration with clinical teams, the RN Navigator identifies the appropriate service line, level of care, and care setting within the health system, supporting patient flow, resource use, and patient-centered outcomes. This is a 12-hour-per-week, regular position with a hybrid work arrangement and a day shift. The role is based at 265 Charles Street. The posted pay range is $41.72–$108.29 per hour.

Requirements

Bachelor’s degree in Nursing.
Massachusetts Registered Nurse license.
2–3 years of experience in an acute care setting, provider practice, community-based role, or with discharge/transitional planning.
Strong attention to detail and organizational skills.
Strong cultural awareness competencies.
Proficiency in Microsoft Office.
Good communication skills.
Ability to adapt to change and welcome new approaches when circumstances demand it.

Nice To Haves

Basic Life Support (BLS) certification; various issuers accepted.
3–5 years of nursing experience, preferably in outpatient care settings.
Experience in palliative care, oncology, geriatrics, emergency medicine, critical care, or other complex care populations.
Experience in nurse navigation, care coordination, case management, or transitions of care.
Demonstrated ability to manage complex patient needs, prioritize referrals, and coordinate care across interdisciplinary teams.
Experience facilitating goals-of-care discussions, discharge planning, and resource coordination.

Responsibilities

Collaborate with referring clinicians to obtain clinical and psychosocial information and triage and prioritize referrals.
Coordinate complex patient care needs and serve as a primary contact for service access, diagnostics, treatment activities, scheduling, education, and multidisciplinary collaboration.
Help create tailored healthcare plans with the interdisciplinary team and develop individualized service plans with the physician.
Facilitate communication and coordination among interdisciplinary teams and specialty services to promote continuity and alignment of care plans.
Educate clinicians and staff on pathway criteria and support appropriate patient entry into designated programs.
Monitor patient progression through the continuum of care and support timely placement in the next appropriate level of care or disposition setting.
Gather clinical and social information to identify the appropriate service line, level of care, and care setting.
Report pertinent patient observations and reactions to the appropriate person, such as a primary care provider, social worker, or director.
Assess and coordinate discharge-planning needs with members of the healthcare team.
Resolve patient problems and needs using multidisciplinary team strategies.
Educate patients on how to navigate the health system.
Facilitate goals-of-care discussions, discharge planning, and resource coordination when appropriate.