RN Navigator

Mosaic Community Health•Bend, OR

About The Position

The RN Navigator is a registered nurse who provides clinical navigation and care coordination for patients across Mosaic’s ambulatory continuum. Serving as a consistent point of contact, the RN Navigator uses the nursing process to provide protocol-driven guidance, risk-stratified follow-up, and transitions among primary care, specialty partners, emergency departments, and community services. The role focuses on high-risk patient follow-up and complex care coordination, supporting timely communication and effective navigation for patients with complex needs. The RN Navigator also serves as a resource for urgent and complex referrals, coordinates with internal and external partners, and supports high-risk laboratory and diagnostic follow-up. Candidates must live in Central Oregon. The position involves providing care within the scope of nursing practice and current competencies, including telephone triage, and documenting interactions in the EHR. The navigator may support adult and pediatric populations as assigned and participates in quality improvement initiatives and tracking navigator metrics. Mosaic Community Health describes itself as an innovative health system that has served insured and uninsured patients since 2002, regardless of age, ethnicity, or income. It uses a holistic approach to care that incorporates behavioral health, pharmacy, and nutrition support. The organization describes its work environment as a dynamic, team-based environment with mission-centered peers and promotes work/life balance and community service.

Requirements

Associate degree.
Current, unrestricted Oregon RN license.
BLS/CPR certification.
Valid Oregon State driver’s license.
Superior nursing process skills.
Critical-thinking and problem-solving skills.
Excellent written, verbal, telephone, and interpersonal communication skills.
Familiarity or experience with client interaction by telephone.
Knowledge of community resources.
Basic typing and computer skills and comfort with the Microsoft Windows operating system.

Nice To Haves

At least two years of RN clinical experience in acute or ambulatory care.
Care coordination experience in an ambulatory setting.
Experience working with pediatric patients.
Bachelor of Science in Nursing (BSN).
EHR experience; EPIC experience is a plus.
Spanish fluency.
Involvement with quality improvement processes.
Knowledge of health insurance plans, standard office policies and procedures, and regulatory requirements including CLIA and OSHA standards.

Responsibilities

Coordinate care for complex and high-risk patients using evidence-based practice.
Support patient care needs with external partners to facilitate transitions among primary care, specialty providers, and community services.
Manage urgent and complex referrals to facilitate timely and appropriate patient care.
Follow up on high-risk laboratory and diagnostic results, ensuring prompt action on abnormal results and coordinating interventions.
Perform emergency department follow-up by contacting patients according to risk stratification to support safe transitions and continuity of care.
Coordinate care needs for patients and/or caregivers in community settings, including assisted living facilities, skilled nursing facilities, foster homes, and residential treatment facilities.
Educate patients and family members about chronic disease management, acute conditions, and preventive health behaviors.
Use standing orders to manage patient care.
Perform patient outreach and follow-up as directed.
Provide patient care within the scope of nursing practice and current competencies, including telephone triage.
Document interactions in the EHR in a timely, thorough, and accurate manner.
Provide population-specific navigation for adults and pediatric patients as assigned.
Participate in quality improvement initiatives, track navigator metrics, and contribute to adoption of evidence-based practice.
Maintain accurate and timely documentation aligned with nursing practice models, policies, and regulatory requirements.