Neurosciences TCM Registered Nurse Patient Navigator

Why Crouse Medical Practice?

At Crouse Medical Practice, our focus is on improving the lives of our patients. This focus is what drives us to recruit the best employees to support our patients. Our practice fosters an inclusive environment that prioritizes work-life balance, welcoming individuals from all backgrounds to join our close-knit work family.

Here’s what we offer:

• Monday-Friday work week with no mandatory overtime
• Supportive team environment
• Competitive starting rates based on experience
• Annual salary increases
• Opportunities for professional growth & stability within a fast-growing Medical Practice
• Longevity and consistency of management
• Perfect attendance award
• Tuition reimbursement program
• Employee referral program
• Affiliation with Crouse Hospital

Other benefits include: Generous Health/Dental/Vision & Life insurance, Flexible spending account or Health savings account – available first of the month following your date of hire, Employee assistance program, 15 days of paid time-off within first year of employment, 7 paid holidays annually, and a 401k with 4% employer match.

Position Overview:

The Transitional Care Management (TCM) Registered Nurse (RN) Patient Navigator is a key member of Crouse Medical Practice who will care of patients between settings (hospital/home/rehab). They will focus on preventing readmissions by creating detailed plans, educating patients/families on medications/self-care, connecting with community resources, and ensuring seamless follow-up, requiring strong assessment, communication, and organizational skills.

Duties:

• Care Coordination
  • Develops comprehensive transition plans with providers, patients, and families for discharge, bridging gaps between acute care, rehab, and home.
  • Coordinates post-discharge care, conducting post-discharge outreach, and assisting with stroke education for the staff and the communities served.
  • Collaborates with Stroke Coordinator, Stroke Medical Director, Core Stroke Team to help implementation of Stroke program goals and objectives.
• Patient/Caregiver Education to teach medication management, rehabilitation goals, signs of complications, and self-management skills for long-term recovery.
• Conducts a needs assessment to evaluate functional status, social determinants of health (SDOH), and support systems to identify potential barriers.
• Resource Navigation to connect patients with community services, home health, and outpatient therapies.
• Assesses patients and family understanding of patient condition, goals of care and ongoing management.
• Conducts post-discharge calls/visits to monitor progress, address issues, and ensure continuity of care.
• Accurately records transition issues and communicates the plan to subsequent care providers.
• Maintains knowledge of best practice and evidence-based care regarding neurological and cardiovascular disease entities.
• Supports the clinical and professional development of nursing and staff through mentoring, role modeling, and educating to promote and enhance clinical skills.
• Optimizes outcomes to improve quality of life and reduce unnecessary hospital readmissions for patients by ensuring a smooth, well-supported journey across the healthcare continuum.

Required Qualifications:

• Associate’s degree in nursing from an accredited nursing school.
• Current New York State Licensure as a Register Nurse.
• Minimum of two (2) years of neuroscience/critical care experience.
• Active Basic Life Support certification

Desirable Qualifications:

• Bachelor’s degree in nursing from an accredited nursing school.
• Current National Institutes of Health Stroke Scale (NIHSS) Certification or completion within three (3) months of hire.
• Neuroscience or Stroke Certification, such as Stroke Certified Registered Nurse (SCRN).
• Certified Neuroscience Registered Nurse (CNRN).
• Neurovascular Registered Nurse (NVRN).

This position may have the ability to work-from-home after the initial onsite (in-office) training is completed.

Pay Range: $62,353.20 - $77,000 DOE