Oncology Quality & Care Pathways Navigator

Department / Reporting Relationship

Department: Compliance
Reports To: Director of Clinical Programs
FLSA Status: Exempt

Position Summary

The Oncology Quality & Care Pathways Navigator serves as the clinical quality resource for the Oncology Service Line. This position partners with physicians, advanced practice providers, nursing, pharmacy, infusion services, and ancillary departments to promote evidence-based, high-quality cancer care across the continuum of treatment.

The incumbent performs comprehensive chart reviews, monitors adherence to National Comprehensive Cancer Network (NCCN) guidelines and organizational treatment pathways, identifies gaps in care, evaluates medications and supportive therapies, validates documentation, and collaborates directly with providers to improve patient outcomes. The role supports quality improvement initiatives, accreditation readiness, and clinical standardization while ensuring timely, coordinated, patient-centered care.

Purpose of the Position

To ensure oncology patients receive evidence-based, timely, and coordinated care by monitoring compliance with established care pathways, identifying opportunities for clinical improvement, and partnering with providers to improve quality, safety, and outcomes.

Essential Functions

Clinical Quality & Pathway Oversight

• Review newly diagnosed oncology patients to verify appropriate staging, diagnostic testing, biomarker evaluation, and treatment planning.
• Monitor adherence to NCCN Guidelines, evidence-based pathways, and organizational standards.
• Identify clinical care gaps and collaborate with physicians regarding appropriate follow-up and documentation.

Comprehensive Clinical Chart Review

• Audit medical records throughout the patient's continuum of care.
• Validate treatment sequencing, laboratory monitoring, imaging, referrals, and follow-up.
• Ensure documentation accurately reflects diagnoses, clinical decision-making, and treatment response.

Medication & Supportive Care Review

• Review chemotherapy, immunotherapy, targeted therapy, endocrine therapy, and supportive care medications.
• Evaluate medication reconciliation and supportive care interventions.
• Collaborate with providers and pharmacy to resolve medication-related concerns.

Care Coordination

• Monitor patients for overdue visits, imaging, laboratory testing, treatment, or surveillance.
• Coordinate care among physicians, APPs, infusion services, nursing, pharmacy, and outside providers.
• Assist with transitions of care and removal of barriers that delay treatment.

Physician Collaboration

• Serve as a clinical resource to physicians and APPs.
• Participate in multidisciplinary conferences, tumor boards, and quality meetings.
• Provide objective clinical observations and recommendations to support evidence-based care.

Quality Improvement & Accreditation

• Track oncology quality indicators and pathway compliance.
• Support QOPI, Commission on Cancer, or other accreditation initiatives, as applicable.
• Develop reports, identify trends, and recommend workflow improvements.

Decision-Making Authority

• Independently identify clinical care gaps and documentation deficiencies.
• Recommend evidence-based interventions and follow-up based on established oncology pathways.
• Escalate complex clinical issues to the Director of Clinical Programs or treating physician.
• Prioritize daily work activities to meet quality and patient care objectives.

Key Performance Indicators (KPIs)

• Pathway compliance rates
• Timeliness of chart reviews
• Identification and resolution of care gaps
• Documentation accuracy
• Reduction in treatment delays
• Patient follow-up compliance
• Physician satisfaction
• Quality metric performance
• Accreditation readiness
• Patient outcome improvement initiatives

Physical Requirements

Work is primarily performed in an office and clinical environment. Requires prolonged sitting, standing, walking between clinical areas, computer use, and the ability to review electronic medical records for extended periods. May require occasional lifting up to 20 pounds.

Success in this Role is Measured By

Success is demonstrated through consistent delivery of evidence-based oncology care, improved pathway compliance, accurate and timely chart review, effective physician collaboration, reduction of care gaps, support of accreditation standards, and measurable improvements in patient quality outcomes.

Required Qualifications

• Registered Nurse (RN), Nurse Practitioner (NP), or Physician Assistant (PA), Certified Medical Assistant (CMA).
• Minimum five (5) years of oncology or Urology clinical experience.
• Demonstrated experience auditing oncology or Urology medical records or managing complex oncology patients.
• Knowledge of oncology staging, biomarker testing, treatment sequencing, and NCCN Guidelines.
• Excellent critical thinking, communication, and physician collaboration skills.

Preferred Qualifications

• Oncology Certified Nurse (OCN).
• Oncology Nurse Navigator Certification (ONN-CG).
• Experience with QOPI, Commission on Cancer, or similar quality programs.
• Experience with oncology pathway management software and EMR reporting.

Core Competencies

• Clinical Judgment
• Quality Improvement
• Critical Thinking
• Physician Collaboration
• Analytical Chart Review
• Oncology Expertise
• Communication
• Attention to Detail
• Organization & Time Management
• Professionalism