Ambulatory Nurse Navigator

Assists patients and caregivers in navigating care services through the continuum, including development of patient-tailored post-acute care plans, assisting with timely access to care, coordinating/facilitating appointments and services, and routine patient monitoring to ensure adherence to treatment plans, protocols, and follow-up care. Assesses and advocates for patients’ current and future needs by proactively identifying barriers to treatment plans and ensuring patients have access to needed prescriptions, durable medical equipment, and the REACH team/Social Services, as well as other internal and external resources, making appropriate referrals as needed.

Position Summary:

 

Ambulatory Nurse Navigator

 

South Lake Hospital serving Jewett Orthopedic Institute 

Full-Time

 

A Brief Overview
Enhances the patient experience by providing seamless navigation and supportive care transition services across the care continuum. Collaborates with all members of the multidisciplinary team to coordinate and consistently manage patient care by serving as a point of contact for patients and families. Systematically and continually performs the functions of assessing, planning, implementing, and evaluating care according to the nursing process and specialty nursing society standards of practice.

 

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Qualifications

• Bachelor of Science in Nursing (BSN) required.
• Assumes responsibility for and collaborates with the clinical leader on professional development and continuing education.
• Meets all mandatory and developmental requirements for Orlando Health and the unit/department.
• Two (2) years of experience as a registered nurse.
• Experience within the specialty and/or navigation or care coordination/management experience preferred.
• Meets unit/department specific performance competencies and may be required to take specialty courses or training to qualify.
• Maintains license as an RN in the state of Florida.
• Maintains current BLS/healthcare provider certification.
• Where applicable, current nursing certification in the specialty area of care is preferred at hire; otherwise, it must be completed within one (1) year of hire/placement and maintained while in the role (e.g., Oncology Nursing Society (ONS) certification, Congestive Heart Failure Nurse (CHFN) certification, Orthopedic Nurse Certification (ONC), etc.).

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What you will do

• Possesses a strong understanding of medical terminology and an understanding of healthcare operations, patient engagement, physician relations, and all other healthcare related issues.
• Demonstrates and takes initiative to develop knowledge, skills, abilities, and coordination to provide nursing care and guidance to the patient and to perform at a high level in the navigation role, including staying abreast of related care transition management and navigation news, documentation, and literature.
• Ensures compliance with all necessary risk management programs, corporate quality initiatives, and other corporate objectives.
• Partners with various healthcare entities and physician practices to foster integrated relationships with patients, families, and caregivers to facilitate streamlined patient transitions across the continuum of care.
• Assists patients and caregivers in navigating care services through the continuum, including development of patient-tailored post-acute care plans, assisting with timely access to care, coordinating/facilitating appointments and services, and routine patient monitoring to ensure adherence to treatment plans, protocols, and follow-up care.
• Engages with patients using strong communication skills and utilizes patient feedback to identify current service needs and anticipate future service needs using a patient-first philosophy.
• Demonstrates effective communication with peers, members of the multidisciplinary healthcare team, and community organizations and resources.
• Obtains or develops patient and family educational materials and resources.
• Provides education and information to patients and caregivers related to the healthcare system, multidisciplinary team member roles, and the plan of care, along with available resources to effectively remove barriers, with the goal of preventing readmissions and other avoidable care events.
• Serves as a preceptor for team members, supporting their orientation, training, and professional growth.
• Assesses and advocates for patients’ current and future needs by proactively identifying barriers to treatment plans and ensuring patients have access to needed prescriptions, durable medical equipment, and the REACH team/Social Services, as well as other internal and external resources, making appropriate referrals as needed.
• Establishes and maintains close collaboration with physicians and multidisciplinary team members to ensure seamless patient care and care coordination and collaborates with relevant network aligned physician partners to share, discuss, and modify care transition plans, as needed.
• Supports patients and families during the transition from active treatment to health maintenance or survivorship and preventative care or assists with coordination of end-of life care.
• Contributes to the development, implementation, and evaluation of the nurse navigator role.
• Maintains a high level of proficiency with organizational informational systems, including ELLiE Healthy Planet modules, to ensure care transition support for our covered populations is efficient, timely, and effective.
• Performs other duties as assigned to support the organization’s overall objectives.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.
• Works comfortably in teams as a participant and facilitator, including temporary teams for project-based initiatives.
• Possesses the ability to prioritize and work independently in addition to being an integral part of the care team.
• Communicates effectively through all forms of media and leverages critical thinking skills to effectively solve problems.
• Documents work efforts in an organized and accessible fashion while respecting confidentiality and privacy standards.
• Actively participates in multidisciplinary planning conferences.
• Builds awareness of the nurse navigator role by participating in marketing and community outreach efforts.
• Participates in community health promotion and awareness programs (health fairs, screenings, symposiums).
• Attends staff development in-services, department meetings, etc.
• Establishes and maintains professional role boundaries with patients, families, and the multidisciplinary care team.
• Serves as advocate for patients and family.
• Contributes to an environment of psychological safety where ideas are welcomed, considered, and appreciated.