Outpatient Nurse Navigator - ACO

INSIGHT Surgical Hospital•Coldwater, MI

22h

About The Position

Outpatient Nurse Navigator - ACO A Care Management Role Designed to Work At Insight, we’ve built our ACO care management program with one goal: Give nurses the time and structure to impact patient outcomes. This is not a high-volume, task-driven role. Our RN Care Managers support a manageable panel of <300 high-risk patients, allowing for meaningful engagement, proactive care, and real results. If you’re tired of being stretched too thin to make a difference, this role was built differently. What You’ll Do Manage a Defined High-Risk Patient Panel Proactively manage a panel of <300 high-risk patients Build longitudinal relationships—not one-time interactions Develop and execute individualized care plans Coordinate Care Across the Continuum Serve as the central point of coordination between: Primary care Specialists Hospital and ED Post-acute and community services Ensure smooth transitions after hospital or ED visits Prevent Avoidable Utilization Identify early warning signs and intervene before escalation Reduce unnecessary ED visits and hospitalizations Close gaps in care and improve follow-up compliance Use Data to Drive Action Leverage risk stratification tools and EMR insights Prioritize outreach based on patient risk and need Track and improve quality and outcome metrics Engage Patients & Families Provide coaching using motivational interviewing and education Help patients navigate complex healthcare needs Address barriers including transportation, medications, and social determinants Partner with Providers Collaborate closely with primary care and specialists Align care plans and communicate patient needs effectively Support value-based care initiatives and performance goals What Makes This Role Different Manageable panel size (<300 high-risk patients) Focus on proactive care—not reactive task completion Strong collaboration with providers and care teams Opportunity to build relationships and see impact over time Designed to support value-based care success—not just documentation What Success Looks Like Reduced ED visits and hospitalizations Improved chronic disease management High patient engagement and adherence Strong provider collaboration and trust Measurable improvement in quality metrics Who You Are You’re proactive, organized, and relationship-driven. Why This Role Matters: This is where healthcare is going. You’ll help patients: Stay out of the hospital Better manage chronic conditions Navigate the system with confidence And you’ll do it in a role that is structured to allow you to succeed. About Insight Insight is committed to improving care beyond the hospital through strong outpatient and population health programs that prioritize outcomes, access, and patient experience. Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or other status protected by applicable law. Insight is an Equal Opportunity Employer Workplace