Clinical Services Navigator RN

We are ushering in a new era of healthcare where achieving good health is just the beginning. At UVA Community Health, part of the world-class UVA Health academic health system, we are committed to caring for the whole person by building meaningful connections with our patients i n the local setting of UVA Health’s community hospitals, outpatient locations, and provider offices.

By combining our team’s talent and expertise, the breadth of capabilities across the entire UVA Health system, and our dedication to community wellness, we are bringing expert care close to home. As a member of the UVA Community Health team, individuals contribute to patient care decisions, support advanced medical technologies, and experience the satisfaction of making a difference in people’s lives every day.

The Clinical Services Navigator will facilitate care coordination from acute to ambulatory and is a valued member of the healthcare team. They collaborate with Physicians, Case Managers, and other members of the healthcare team to facilitate coordination of care and follow-up appointments to the ambulatory setting. Collaborates with Case Managers for guidance with medically and/or psychosocially complex cases. Serves as a resource for care coordination.

Maintains current knowledge of available community resources, post-acute care and ambulatory options.

4 Year/Bachelor's Degree preferred.

2 years of experience preferred. 5 years of clinical experience with knowledge in the care of disease specific population preferred. Refer to the Life Support Training Policy for additional details.

RN required. Certified in specialized area preferred. National specialty certification required, or obtained within 2 years, if applicable to position.

Demonstrates effective communication skills to provide patient education. Demonstrates effective communication skills to discuss case management, financial, clinical issues with hospital-based case managers, physicians, outside agencies and facilities, nurses, and other healthcare professionals in the community. Autonomous, self-starter with the ability to make independent decisions. Organized with effective time management skills. Detail oriented with ability to facilitate change and affect positive results.

Proficient in computer/web-based tools.

N/A

• Patient Care &
  
  Education:
  • Provides patient and family education regarding the surgical pathway, ERAS protocols, recovery expectations, and discharge planning.
  • Reinforces health promotion, mobility, and illness prevention strategies in collaboration with the care team.
  • Reviews patient records to identify needs, barriers, and opportunities for support across the care continuum.
  • Recommends and connects patients/families to appropriate community resources and support services.
  • Provides ongoing patient phone contact pre- and post-operatively to ensure understanding, readiness, and continuity of care.
• Quality & Safety:
  • Collaborates with interdisciplinary teams to achieve desired quality outcomes (e.g., reduced LOS, readmission prevention, infection reduction, and same-day discharge targets).
  • Monitors patient outcomes and pathway adherence to identify trends and opportunities for improvement.
  • Applies principles of safety and infection prevention in all patient interactions.
  • Participates in quality initiatives, audits, and process improvement activities to support departmental and organizational goals
• Demonstrates strong interpersonal and communication skills in interactions with patients, families, and colleagues.
• Functions as a central point of contact for patients, ensuring consistent…