RN Nurse Navigator - Positive Health Clinic - Pittsburgh - FT

Highmark Health•Pittsburgh, PA

About The Position

The RN Nurse Navigator serves as a consistent point of contact for referring physicians, patients, caregivers, families, and the community. The role facilitates patient flow by coordinating appointments and helping patients access clinical and supportive care services within the Network. The Nurse Navigator coordinates care for adult patients with a specialized disease state in collaboration with a multidisciplinary team to help ensure quality, comprehensive services. The role also identifies community needs and provides education, screening, support, referrals, care coordination, and other identified assistance. The position oversees community outreach and work with high-risk populations and disease-specific sites, building and sustaining relationships across the Network. It educates patients about diagnoses, treatment options, treatment courses, clinical trials, and available resources; coordinates multidisciplinary appointments; supports safe transitions of care; and addresses medication adherence. The Nurse Navigator tracks program data and outcomes, identifies opportunities to improve care across the continuum, and reports on active patients at clinical care conferences. Travel to other facilities may be required.

Requirements

Current Pennsylvania RN licensure or current multistate licensure through the enhanced Nurse Licensure Compact (eNLC).
Bachelor’s degree.
CPR certification from the American Heart Association.
Act 34 Criminal Background Clearance Certificate.
Act 33 Child Abuse Clearance Certificate.
Act 73 FBI Fingerprinting Criminal Background Clearance Certificate.

Nice To Haves

Certification in area of expertise.
Valid Pennsylvania driver’s license.
Knowledge of the healthcare delivery system, resources, and community for the disease-site specialty, and patient advocacy skills.

Responsibilities

Serve as a consistent point of contact for referring physicians, patients, caregivers, families, and the community.
Facilitate patient flow and coordinate appointments and access to clinical and supportive care services.
Coordinate comprehensive care for adult patients with specialized disease states in collaboration with the multidisciplinary team.
Identify community needs and provide education, screening, support, referrals, care coordination, and other identified assistance.
Oversee community outreach and work with high-risk populations and disease-specific sites to establish and sustain relationships within the Network.
Work with physician offices and facilities to identify at-risk patients and facilitate appropriate screening.
Educate patients and coordinate care regarding diagnoses, treatment options, course of treatment, clinical trial information, and available resources.
Coordinate safe handoffs and care transitions between facilities and between inpatient and outpatient settings.
Identify family bereavement needs and develop a plan of care when applicable.
Work with the Stroke Team to reduce readmissions when applicable.
Assist Registry staff with data collection, patient outcomes, and updates to care delivery models when applicable.
Coordinate multidisciplinary appointments and accompany patients to appointments as needed.
Ensure medication adherence issues are addressed.
Trend program data and outcomes and identify gaps and opportunities to improve patient care across the continuum.
Develop or attend clinical care conferences and report on active patients to the multidisciplinary team.
Travel to other facilities as required.