Nurse Navigator

REPORTS TO:

Clinical Nurse Navigator Program Coordinator unless providing direct patient care and will then report to the Nurse Manager.

An oncology nurse navigator is a professional registered nurse with oncology-specific clinical knowledge who offers individualized assistance to patients, families, and caregivers to help overcome healthcare system barriers. Utilizing the nursing process, an oncology nurse navigator provides education and resources to facilitate informed decision-making and timely access to quality health and psychosocial care throughout all phases of the cancer continuum.

• Identify and assist patients with individual barriers to care and match resource to address the barriers
• Collaborate with physicians and other healthcare providers to identify and reduce barriers
  • Including: psychosocial, financial, legal, nutritional, housing, transportation, child/elder care
  • Will investigate and match resource to identified barriers.
• Ensure timely access to appropriate care.
• Assist patients with referrals to outside resources and care coordination as needed.
• Collect and report data from patient on barriers, health care, medications, prior treatments, etc.
• In conjunction with clinic staff, oversee the planning, scheduling, and implementation of day-to-day clinical activities and procedures for navigated patients.
• Advocate on behalf of patients to reduce disparities in cancer care.
• Promotes a smooth transition for patients from diagnosis, treatment, survivorship, chronic pain and/or end of life care.
• Identify patients within value-based care programs and comply with all required quality metrics and assessments.
• Assists in the identification of molecular testing candidates and assists with appropriate referrals.
• Assist with the tracking, adherence and required education for oral oncolytic medications.

Use appropriate screening tools to promote holistic plans of care based upon identified risk.

• NCCN distress score
• ECOG
• PHQ-9
• NCI Oral Assessment
• Risk-based electronic assessment tools

• Utilize care manager and patient portal applications to promote patient resource and education.
• Create contacts within local and community health, wellness and social care programs.

• Facilitate communication among patients, providers, and other agencies.
• Advocate for patient-centered care and shared decision-making.
• Document and communicate patient navigation activities and patient outcomes.
• Collaborate with other navigators to share best practices and increase patient resources.

• Prepare patients and caregivers on what to expect.
• Provide education to patients, families, and significant others regarding caregivers, multi-disciplinary team members and available resources.
• Monitor patient compliance with treatment plan; reinforce patient education for treatment options, side effect management and post-treatment care/survivorship.
• Educate and coach multidisciplinary colleagues about the role of the nurse navigator, identified barriers, available resources, and navigation process.
• Educate and reinforces adherence with the patients, families and caregivers regarding treatment plan, schedule and follow up.
• Create and/or maintain oncology related education materials for patients and staff.
• Provide education on genomic and molecular testing and meaning of results.

• Develop and assist in gap analysis, quality improvement projects and data reports to make…