Nurse Navigator

JOB SUMMARY/RESPONSIBILITIES:  

As our Nurse Navigator/Pre Admit RN, you’ll be an educator and advocate for our patients. In this role, you can expect to coordinate patient engagement throughout the entire  Health episode of care from days before surgery through months following surgery.  Collaborating with our multidisciplinary team, you will effectively coordinate patient care, ensure continuity of care and create a comfortable and exceptional patient experience. Our Nurse Navigator can manage the pre-op to post-op recovery phase for each patient through checkpoints and early intervention. You will serve as a liaison and will work to actively coordinate the work of practitioners who will be a defined part of the navigation cycle. In the preadmit role you are responsible for all patient assessments prior to the admission/ day of surgery via a phone interview, collects patient medical history, and works closely with the anesthesia department in coordinating patient's needs. 

• Support and promote the total joint and spine program established to reduce the patient length of stay and avoid hospital readmissions as much as possible through nursing assessments, physician consultation and patient/family care plan coordination. 

• Coordinate all patient engagement functions including primary input into the development of patient education and engagement materials, coordination of patient education, coordination of direct contact with patients during pre-surgery evaluation and preparation, surgery and hospitalization, and following discharge from the hospital. 

• Review and incorporate in care plan information from nursing assessments, physician integration and provided reports 

• Develop trust and rapport with patients and families when patients are in the Programs to insure access to patients upon discharge; track patients in the home setting with the goal of preventing hospital readmissions. 

• Act as central point of contact for the patient and family during the 90 day episode 

• Assist in service line development to improve patient care 

• Track closely patients who have complications or are readmitted, in an effort to bring the patients back in an effort to better coordinate care and reduce hospital readmission. 

• Identify the quality and performance measures 

• Monitor clinical quality measures in real-time, intervening where possible to improve quality or minimize complications once they do occur 

• Provides assessments of quality metrics and recommends areas for improvement with all clinical departments 

• Provide primary input to identifying measures of quality for the entire episode of care 

• Provide primary input into education needs prior to surgery for patients to understand how to plan for recovery and prevent complications 

• Provide primary input into the design and development of education materials for patients, including in-person education, presentations, guidebook materials, digital materials, and videos; supported by marketing and the integration team 

• Coordinate the maintenance of up-to-date content of patient education 

• Adheres to The Joint Commission professional standards and attends in-service training sessions as directed.  Provides age-appropriate care for all age groups 

 

 Knowledge/Responsibilities: 

PreAdmit Nursing Duties:  

•  Practice appropriate telephone and patient triage skills, being aware of the need to balance quality care with efficient use of time and resources. 

•  Perform verbal assessment with patient prior to admission – in person or via telephone, communicating information to appropriate team members. 

•  Ensure pre-operative care requirements of patients are accomplished through use of the nursing process including assessment, planning, implementation and evaluation