Outpatient Nurse Navigator, Supportive and Palliative Care, Newark, DE Job at ChristianaCare, Newark, DE

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  • ChristianaCare
  • Newark, DE

Job Description

Job Description

ChristianaCare is currently seeking a full-time outpatient Nurse Navigator for our Supportive and Palliative Care practice in Newark, DE.

Work Schedule

  • Monday-Friday, day shift
  • No weekends or holidays required

Principal Duties and Responsibilities

Coordination of Care

  • Assists Palliative Care staff with coordinating referrals from within and outside of Christiana Health Care.
  • Completes a review of the patient upon initial encounter and periodically throughout navigation, matching unmet needs with appropriate services.
  • Assists with identifying potential and realized barriers to care (e.g., transportation, caregiver support, housing, language, culture, literacy, role disparity, psychosocial, employment, financial, insurance) and facilitates referrals.
  • Schedules and/or facilitates scheduling of appointments.
  • Triage of family/caregiver phone calls, messages determining disposition of call. Coordinates response with Palliative clinicians based on clinical assessment and communicates treatment plan/recommendations to patient/caregiver.
  • Organize inpatient palliative census and daily workload. Evaluate and triage consults by collaboration with the hospital team (bedside nurse, consulting providers).
  • Support established inpatients in lieu of Palliative provider consult.
  • Collaborates with the outpatient team for seamless transition.
  • Provides psychosocial support to and facilitates appropriate referrals for patients, families, and caregivers, especially during periods of high emotional stress and anxiety.
  • Supports discussions with patients and caregivers related to goals of care and end of life treatment decisions (hospice). Facilitates scheduling of family/provider meetings.
  • Applies basic knowledge of insurance process (e.g., Medicare, Medicaid, third-party payers) and their impact on staging, referrals, and patient care decision toward establishing appropriate referrals, as needed.
  • Monitors progress in achieving defined patient specific, clinical outcomes through performance improvement activities and outcomes.
  • Manages care flow and navigates multidisciplinary treatment needs (including communication with and coordination of tests, and imaging).

Education

  • Assesses patient and family learning needs to identify barriers to education (e.g., literacy, language, cultural influences, comorbidities)
  • Utilizes “Teach Back method for patient education.
  • Collaborates with multidisciplinary team to develop patients’ clinical treatment plan.
  • Educates the patient/family/caregiver: diagnosis, treatment options, medication side-effect management, behavioral disturbance triage and guidance.
  • Assists patient/family with appropriate information to make an informed decision.
  • Maintain our inpatient patient education resources – (booklets on end-of-life expectations, pamphlets on our team and resources)
  • Provide system education to nurses on nursing role in palliative care (by helping inpatient nurses understand how to interact with hospice, and be a nurse providing comfort care and advocating for basic primary palliative care for their patients)

Communication

  • Facilitates communication among the Palliative Care team to prevent fragmented or delayed care.
  • Acts as a liaison and advocate between the patients, families, caregivers, and health care providers to promote and optimize patient outcomes.
  • Empowers patients and families through education and encouragement to self-advocate and communicate their needs.
  • Adheres to established regulations concerning patient information and privacy.

Professional Role

  • Contributes to Palliative Care program development, implementation, and evaluation within the healthcare system and community.
  • Maintains required credentials and participates in learning to stay current with disease specific information and issues related to memory care, insurance, ethical issues.
  • Contributes to the knowledge base of the healthcare community and in support of the Palliative Care role through activities such as involvement in professional organizations, presentations, publications, and research.
  • Participates in system committees such as magnet, nursing council, safety, cultural competency/diversity, patient education, professional nursing council.
  • Is a Mentor for students and other members of the team.
  • Works with health improvement team to implement and evaluate new processes of care and patient flow which are determined by the team utilizing pathways, guidelines, and algorithms.
  • Supports a culture of safety, respect, and commitment to excellence and inclusivity.

Education and Experience Requirements

  • BSN required.
  • Masters in nursing preferred.
  • RN license or eligible for licensure in the state of Delaware, Pennsylvania, New Jersey, or Maryland
  • Three or more years of combined clinical experience in clinical and/or administrative experience in case management, clinical trials, older adult, palliative/hospice care preferred.
  • Nursing Cert - Certified Hospice and Palliative Nurse (CHPN) - Hospice & Palliative Credentialing Center within 3 years of hire.

Special Requirements

  • RN license or eligible for licensure in the state of Delaware.
  • BLS

Qualified candidates should apply online and include a current resume.

#L1-CS1

Job Tags

Full time, Day shift, Monday to Friday,

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