Nurse Navigator Outpatient- Developmental Delay
2 weeks ago
Job Summary
Assumes responsibility in association with Physicians and Leaders to serve as a liaison for the "community" (referring physicians, patients, and families) and other NCPS Physicians. Assesses, plans, implements, evaluates, and supervises individual patient care according to organizational policies and procedures. Establishes early contact with patients to eliminate barriers to timely diagnosis and treatment by coordination of referrals from physicians and health care facilities. Provides a significant level of patient education related to illness and planned treatment. Provides patients with resources and linkages including community and patient/family support. Assists in meeting needs as identified by patients and families. Works to integrate patient to school setting. Offers and makes referral to community resources.
Job Specific Duties
- Ensures safe and efficient patient care. Works closely with physicians in all specialty areas to coordinate and communicate the patient's care plan.
- Ensures development of a collaborative and streamlined transitional patient and family process and physicians in the community and/or other related services.
- Works and collaborates with multidisciplinary teams to maintain and implement up-to-date coordinated patient care; communicates with all members of the healthcare team on behalf of the patient.
- Develops and follows triage protocols to refer patients to appropriate specialist for diagnosis and treatment. Assists patients/families in obtaining referrals/appointments with needed specialists.
- Collaborates in the development of parameters to stratify risk of each patient based on complexity in conjunction with respective MD directors.
- Reviews patient charts to help triage patients prior to first visit for proper scheduling.
- Proactively develops & enhances protocols for discharge standardization. Assures smooth transition of inpatient/outpatient experiences participating in back to school program.
- Communicates with referring physician's office for the patient's & physician's needs before/after services provided. Serves as liaison to community organization for information and support services.
- Answers patient messages/phone calls related to plan of care and addresses any concerns as needed.
- Identifies, informs & educate patients about their disease. Provides educational & materials to parents. Develops care plans to enhance education & satisfaction; addresses clinical concerns.
- Works with Marketing and outreach departments to educate referring physicians and facilities on available services.
- Collaborates in the screening and referral of patients for eligibility for research clinical trials.
- Serves as a nurse liaison to facilitate coordination of brain wellness clinic-before, during, and follow-up care eliminating obstacle for the patients in the health care system.
- Ensures communication between staff & physicians; responsible for arranging appointments & follow-up; serve as a front-line resource to obtain records, test results & other clinical information.
- Functions as clinical expert/role model for the department, identifying clinical, and communication issues.
- Utilizes data obtained to integrate evidence practice into patient care processes.
- Maintains thorough data of physician and patient inquiries, including outcomes related to timeliness of communication, completed referrals, and outcomes.
- Disseminates new information across the institution and the community. Remains current and at the cutting edge of specialty.
- Provides patients with specific resources (CARDS, FDLRS, Early Steps, Patient Support groups, therapies, etc.).
- Promotes a safe "error free" working environment by consistently performing thorough hand-offs, supporting infection prevention, and other patient safety measures.
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