Palliative Care Nurse Navigator

SHARON S RICHARDSON HOSPICE-posted 4 days ago
Full-time • Mid Level
Onsite • Sheboygan Falls, WI
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The Palliative Care Nurse Navigator (PCNN) will work in collaboration with the palliative care team to provide palliative care services to patients and families in a variety of settings. This position is responsible for facilitating the intake of prospective palliative care patients, supporting current patients, and will be a partner in educating our staff and the community on palliative care. This is a full-time, salaried position with typical hours of 8am-4:30pm and is primarily located at our Sheboygan Falls Administrative Office. This position works collaboratively with the intake team and the providers to expedite referral approval. This position reviews records and communicates with hospitals, facilities, clinic offices, patients and families as needed to gather information. The PCNN documents a medical summary for the patient and communicates with Richardson Palliative Care (RPC) provider as necessary to ensure appropriateness for palliative care. If needed, the PCNN will communicate with the hospice intake team if a patient meets hospice eligibility requirements and aligns with the hospice philosophy of care. The PCNN has an excellent understanding of hospice eligibility requirements, regulations surrounding patients’ admission to hospice care, and the levels of hospice care and can describe these to inquiring patients/families. The PCNN communicates in a sensitive, professional, and empathetic manner.

  • Implements goals for the RPC team in alignment with the overall Sharon S. Richardson Community Hospice (SSRCH) strategy to support program growth and expand access to care.
  • Serves as the primary point of contact for patients and families, overseeing patient centered activities including qualifying referrals; scheduling visits; maintaining patient stratification; coordinating with providers, team members, and volunteers; and supporting goals of care discussions.
  • Coordinates the referral process for patients from palliative care to hospice services with SSRCH, ensuring appropriate communication with the patient/family, as well as the appropriate care team members, the hospice intake team, and admitting team.
  • Educates patients and families on RPC program and personnel, symptom management, treatment decisions, advance care planning, and available support services.
  • Demonstrates advanced clinical and supportive care skills to promote appropriate patient referrals to the most appropriate level of care including SSRCH.
  • Identifies and addresses barriers to care and supports ethical decision-making and conflict resolution related to goals of care and treatment choices.
  • Promotes culturally sensitive, equitable, and inclusive care for diverse patient populations.
  • Ensures clinical practice and communication meets and supports the needs of referral partners.
  • Completes accurate and timely patient documentation in the EMR.
  • Maintains knowledge of agency policies and procedures, federal and state regulations, hospice standards, and RPC best practices.
  • Maintains a working knowledge of SSRCH’s Emergency Operations Plan and contributes to risk assessment, emergency preparedness, and survey readiness, including internal and external audits.
  • Uses appropriate communication channels to address and resolve individual and departmental issues.
  • Participates in quality performance evaluation and program improvement plan initiatives.
  • Serves as a presenter for outreach and educational activities for referral sources, community partners, consumers and internal staff.
  • Performs all other duties as assigned.
  • Registered Nurse, or Licensed Practical or Vocational Nurse, with CHPN or CHPNL credential required within 2 years of hire, valid Wisconsin driver’s license upon hire, recertification as required.
  • Minimum of three years public health, home health nursing or hospice experience.
  • Business acumen with demonstrated ability to understand long-term care, assisted living facilities and medical practice’s function and how to build effective business relationships.
  • Strong public speaking/presentation skills, excellent verbal, and written communication skills. Possess strong problem-solving and critical thinking skills with the ability to analyze data. Maintain working knowledge and awareness of end-of-life issues.
  • Proficiency in the use of Microsoft Office (Excel, Access, PowerPoint, and Word) or similar products.
  • Must have a valid WI driver's license and car insurance on vehicle used to perform job and an acceptable driving record.
  • Experience developing and delivering educational offerings to teams (preferred).
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