Cardiology Heart Failure Nurse Navigator Atlantic Health

Heart Failure Navigator

The Heart Failure Navigator is a specialized clinical professional responsible for coordinating and optimizing care for patients with heart failure across the continuum—from inpatient care through discharge and outpatient management. The role focuses on improving clinical outcomes, reducing readmissions, achieving LOS targets, and ensuring adherence to evidence‑based heart failure guidelines.

The Heart Failure Navigator facilitates seamless transitions across the continuum of care, reduces readmissions, improves compliance with guideline‑directed therapy, and enhances the patient experience through education and coordinated follow‑up.

• Identify and follow heart failure patients during inpatient admission and outpatient encounters
• Coordinate multidisciplinary care (cardiology, primary care, nursing, case management, pharmacy, rehab)
• Facilitate smooth transitions of care from hospital to home, rehab, or outpatient follow‑up
• Ensure post‑hospital discharge appointments are in place prior to discharge

• Ensure adherence to evidence‑based clinical guidelines (e.g., GDMT for heart failure)
• Monitor patients for clinical deterioration and intervene early
• Collaborate with providers to optimize medical therapy
• Review labs, imaging, and diagnostics relevant to heart failure management

• Provide education on:
  • Disease process and symptom recognition
  • Medication adherence
  • Dietary restrictions (e.g., low sodium)
  • Daily weight monitoring and self‑management
• Reinforce discharge instructions and self‑care plans

• Develop and implement strategies to reduce 30‑day readmissions
• Conduct post‑discharge follow‑up calls or visits
• Track and report quality metrics (LOS, readmissions, mortality, compliance)
• Monitor LOS and develop strategies to help achieve targets

• Ensure timely follow‑up appointments (cardiology and primary care)
• Coordinate discharge needs (home care, equipment, medications)
• Address barriers to care such as transportation or medication access

• Participate in heart failure program development and accreditation initiatives
• Analyze data to identify trends and opportunities for improvement
• Support regulatory compliance (e.g., Joint Commission, CMS metrics)

• Maintain accurate documentation in the electronic medical record
• Track patient outcomes and registry data
• Prepare reports for leadership and quality committees

Required:

Preferred:

• Heart Failure certification (e.g., CHFN) preferred

• Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full‑time and part‑time team members)
• Life & AD&D Insurance.
• Short‑Term and Long‑Term Disability (with options to supplement)
• 403(b) Retirement Plan:
  Employer match, additional non‑elective contribution
• PTO & Paid Sick Leave
• Tuition Assistance, Advancement & Academic Advising
• Parental, Adoption, Surrogacy Leave
• Backup and On‑Site Childcare
• Well‑Being Rewards
• Employee Assistance Program (EAP)
• Fertility Benefits, Healthy Pregnancy Program
• Flexible Spending & Commuter Accounts
• Pet, Home & Auto, Identity Theft and Legal Insurance

Atlantic Health, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.