Registered Nurse Navigator - Population Health

Role Overview: The RN Navigator in Population Health manages patient care across the healthcare continuum to improve health outcomes through evidence-based practices, preventive care, and timely interventions.

Key Responsibilities

• Coordinate care for patients with chronic or complex conditions and facilitate discharge planning for smooth transitions.
• Conduct comprehensive patient assessments, develop individualized care plans, and support reducing preventable admissions and ED visits.
• Educate patients on medication management, recognizing worsening symptoms, and the importance of follow-up care.
• Advocate for patients within the healthcare system, ensuring access to necessary services.
• Collaborate with providers, social workers, and community resources for holistic care.
• Monitor patient status, document interactions in EHR, and participate in quality improvement initiatives.
• Ensure compliance with regulatory standards and organizational policies.
  
  

Qualifications & Skills

• Bachelor’s Degree in Nursing preferred.
• Minimum of 3 years clinical experience and 2 years case management experience.
• Knowledge of population health management principles and experience in primary care organizations.
• RN licensure and certification such as CCM or equivalent within 2 years.
• Strong clinical assessment, communication, and interpersonal skills, with proficiency in EHR systems.
  
  

Additional Requirements: Ability to work independently and collaboratively, with a caring approach to patients and colleagues.