Nurse Navigator Primary Care Women Clinic

Job Description

The Patient Navigator provides assistance to patients and family members in an assigned area. Using physical, mental, and social assessment skills, the Navigator collaborates with staff and physicians to coordinate appropriate referrals and resources for patients actively treated and upon discharge. The role functions as a liaison between acute and sub‑acute providers, helping to incorporate assistance with post‑discharge care needs. The Navigator assists with evidence‑based best practices to promote positive patient outcomes, provides education and emotional support, and coordinates efforts to prevent readmissions through quality delivery of care at all levels.

Responsibilities also include developing, collecting, and analyzing data in dashboards used to enhance and coordinate the needs of the patient population.

• 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 of 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 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. 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 to the needs of the patient while being actively treated and upon discharge.
• Documents interventions and referrals in patients’ chart and further follow‑up calls as indicated.
• Collaboration and Partnership
• Consistently communicates/collaborates with the health care team members, patients, and family members to maximize resources and outcomes.
• Communicates, collaborates with community resources to enhance the continuum care to meet the specific needs all all patients and the specific needs of the geriatric patient.
• Maintains knowledge regarding program initiatives based on the geriatric population/needs and incorporates the outcome of the team/committee work into practice.
• Provides education to staff team members based on the developmental needs/limitations of the geriatric population.

• 3 years in acute clinical setting working with 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