Palliative Care Nurse Navigator, Full-time

Job Details

Description

Job Summary

This is a full-time professional position providing care coordination for patients in Serious Illness Services (ex: Palliative Care). This position provides patient/family visits and education per individual program guidelines. In addition, this position provides clinical support to providers in the field and collaborates with Provider Relations to assure prompt communication and education with referral sources. The schedule for this position is Monday-Friday 8:30am-5:00pm; weekends and holidays TBD.

Responsibilities What You Do

• Provide safe, competent, and compassionate nursing care to patients in the Serious Illness program.
• Triage phone calls for palliative care patients as needed to support Palliative Care Triage Nurse
• Support clinicians in the field regarding administrative needs.
• Collaborate with MSWs to facilitate visits as needed for all serious illness services.
• Conduct intake visits to Serious Illness patients to provide program and patient care information, obtain consent for service and evaluate patients/family care needs.
• Conduct regularly scheduled contact with assigned patients. This is face-to-face or telehealth (phone, video) as situation allows.
• Provide appropriate end of life information and education to patients, families and hospital staff relevant to the care of each patient served.
• Communicate patient status changes to PCI, and appropriate TL staff for patient tracking and medical record update.
• Have a comfort level with EOL, Goals of Care discussion and assisting with hospice transition when appropriate.
• Active participation in Interdisciplinary Team Meetings for palliative care programs.
• Assist in transfer of patients and/or patient information between TL programs in collaboration with appropriate staff as needed.
• Provide information on resources available in community.
• Document communication and findings in the patient’s electronic medical record.
• Demonstrates willingness to cross-train to other service lines and/or inpatient PC as needed.
• Assist with data collection as needed
• Perform other duties as assigned by supervisor.
  
  

Expectations How You Do It

• TL Core Values are exemplified in all interactions with internal and external customers.
• Demonstrate excellent customer service and positive communication with patients, families and referral sources.
• Adheres to TL policies, procedures and guidelines.
• Adheres to CMS and state guidelines and nursing standards of practice.
• Adheres to NHPCO Ethical Practices and the American Nurses Association’s Code of Ethics.
  
  

Requirements What You Need

• Registered Nurse with current NC license; BSN preferred
• CHPN certification or willingness to test within 2 years
• Minimum 3 years recent clinical experience; Minimum 2 years home health and/or hospice experience or equivalent. Office nursing experience preferred.
• Excellent verbal and written communication skills required.
• Ability to multi-task and coordinate multiple complex projects simultaneously.
• Knowledgeable about reimbursement sources, Medicare regulations, licensing laws, and accreditation standards
• Competent computer skills
• Current CPR certification
• Must have access to reliable transportation and be able to travel to, enter and function in the homes and facilities of any patients/family in the service area to assess and provide care to confined patients
• Must have and maintain a valid North Carolina Driver’s License, maintain automobile insurance coverage.
• May be required to lift and /or carry items up to 35 pounds
• Must have sensory abilities to complete physical assessment, communicate with patient /family and physician and to complete the reporting and follow-up documentation responsibilities of the job