Discharge Nurse Navigator Job Atlanta area,Georgia USA,Nursing

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Job Summary

The Nursing Discharge Navigator is responsible for coordinating and facilitating safe, efficient, and patient-centered discharges. This role ensures continuity of care by arranging follow-up appointments, completing post-discharge outreach, coordinating prescriptions, providing comprehensive discharge education, and confirming transportation arrangements prior to discharge. A key focus of this position is proactively supporting timely discharge planning to reduce length of stay, particularly for patients with Heart Failure, while maintaining high-quality outcomes and reducing readmissions.

Coordinate and schedule follow-up appointments with primary care providers and specialists prior to patient discharge.

Conduct discharge phone calls to assess patient understanding, answer questions, address concerns, and ensure post-discharge needs are met.

Ensure prescriptions are reconciled, called in, and accessible to patients prior to discharge.

Provide clear and comprehensive discharge education, including medication instructions, symptom monitoring, dietary guidance, weight monitoring, and when to seek medical attention.

Confirm transportation arrangements are secured prior to discharge to ensure safe return home.

Collaborate with physicians, case management, pharmacy, social work, therapy services, and other departments to support safe and timely transitions of care.

Identify and address potential barriers early in the hospitalization that may delay discharge.

Work proactively with the interdisciplinary team to streamline discharge processes and decrease length of stay for Heart Failure patients through early education, medication coordination, and post-discharge planning.

Support Heart Failure management initiatives aimed at reducing readmissions and improving clinical outcomes.

Document discharge coordination activities accurately and timely in the medical record.

Track and support quality metrics related to length of stay, readmissions, and follow-up compliance.

Qualifications

Bachelors in Nursing

3+ years of clinical nursing experience

Nurse case management experience

GA RN license

Core Competencies

Patient-Centered Care – Demonstrates a commitment to delivering safe, compassionate, and high-quality care that prioritizes the well‑being and satisfaction of patients and their families.

Integrity & Accountability – Acts ethically, maintains confidentiality, and accepts responsibility for actions, decisions, and outcomes.

Collaboration & Teamwork – Builds positive relationships, works effectively across departments, and supports colleagues to achieve shared goals.

Communication – Communicates clearly, respectfully, and effectively with patients, families, colleagues, and leadership.

Respect & Inclusion – Creates an inclusive environment by valuing diversity, treating others with dignity, and ensuring equitable care and opportunities for all.

Quality & Safety – Adheres to best practices, regulatory standards, and policies to ensure safe, reliable, and high-quality outcomes.

Adaptability & Resilience – Responds effectively to change, remains flexible in dynamic situations, and demonstrates resilience under pressure.

Continuous Improvement – Seeks opportunities to improve processes, skills, and outcomes through innovation, learning, and feedback.

Leadership & Professionalism – Inspires, guides, and develops individuals and teams while modeling professionalism, fairness, and transparency.

Employee Experience Focus – Champions a supportive and engaging employee journey that…