Nurse Navigator Rheumatology Clinic

Job Title:

Nurse Navigator – Rheumatology Clinic, FMOL Health

Baton Rouge, LA

The Patient Navigator provides assistance to patients and family members in the Rheumatology Clinic area. Using physical, mental, and social assessment skills, the Navigator works in collaboration with staff and physicians to coordinate appropriate referrals and resources during active treatment and upon discharge. Functions as a liaison between acute and sub‑acute providers to assist with post‑discharge care needs, promotes evidence‑based best practices to improve outcomes, provides education and emotional support, and coordinates efforts to prevent readmissions.

The role includes data development, collection, and analysis to build dashboards that enhance patient population care.

• Clinical Practice and Care Management
• Provides individualized, appropriate care in collaboration with staff members. Assists with the development of a patient‑specific plan of care based on the goals of treatment and patient’s needs.
• Works with patient and significant others to determine treatment and rehabilitation goals for desired outcomes based on the developmental needs of the patient.
• Assist with collection of specified data in evaluating the quality of care provided.
• Facilitates patient throughput in the admission/discharge/transfer process.
• Serves as a clinical resource to all members of the interdisciplinary team.
• Communicates and coordinates critical information related to risk issues to staff and physicians to ensure patient safety in the acute and sub‑acute setting.
• Performs physiologic/psychosocial assessments to assist with the development of an individualized plan of care based on specific needs of the patient.
• The formulation of individualized plans of care considers patient’s education and discharge planning needs. Prioritizes the delivery of care to the individual needs including cultural, ethical, and spiritual needs.
• Participates in the planning of routine transitional health care needs (i.e., treatment options, patient placement options, end‑of‑life care (LaPost) discussion and options).
• Adapts planned education and information to individual patients and families by modifying teaching strategies or content, integrates education during the delivery of care, and collaborates with patients/families to identify realistic desired outcomes based on developmental needs and restrictions.
• Actively advocates for patient rights and identifies potential conflict.
• Identifies variances from expected outcomes based on assessment and evaluation.
• Evaluates patient outcomes and makes revisions in the plan of care.
• Delegates and requests assistance from members of the interdisciplinary team in coordinating the needs of the patient while being actively treated and upon discharge.
• Documents interventions and referrals in patient’s chart and follows up with calls as indicated.
• Collaboration and Partnership
• Consistently communicates and collaborates with the health care team members, patients, and family members to maximize resources and outcomes.
• Communicates and collaborates with community resources to enhance the continuum of care to meet the specific needs of all patients and the specific needs of the geriatric population.
• Maintains knowledge regarding program initiatives based on the geriatric population/needs and incorporates the outcomes of the team/committee’s work into practice.
• Provides education to staff team members based on the developmental needs/limitations of the geriatric population.

• 3 years in an acute clinical setting working with a population related to your expertise
• Bachelor’s degree in nursing
• Proficient in English, verbal and written communication, and computer skills
• Current and unrestricted Louisiana RN license; BLS

• Mid‑Senior level

• Full‑time

• Health Care Provider

• Hospitals and Health Care