Overview: The Renal Nurse Navigator works as a key member of the nephrology team serving as point person, consistent contact for, and coordinator of multidisciplinary clinical care delivery to achieve exceptional patient/family-centered care and clinical outcomes for an identified population of renal failure patients, especially for those receiving peritoneal dialysis. The Renal Nurse Navigator partners with other members of the team to identify the caseload of patients who can best benefit from navigation services, and to build and execute a customized plan of care for each of those patients. The Renal Nurse Navigator ensures patient preparedness for appointments, outpatient treatment, and treatment plans through education and psychosocial support, while also facilitating interaction between patients and their attending and referring physician(s) as appropriate. The Renal Nurse Navigator ensures patient safety and quality of care and contributes to quality driven performance improvement initiatives. The Renal Nurse Navigator assists the clinical and leadership team with program development, expansion and successful achievement of programmatic goals. Responsibilities • 1. The Nurse Navigator focuses on: Navigating the patient and family across care settings according to the established patient care plan and clinical pathways. • 2. Ensuring that the patient and family have appropriate information, understand and have the capacity and tools to adhere to the therapeutic plan. • 3. Bridging patient and family care among and between various disciplines, services, and points of care encountered by the patient/family. • 4. Optimizing patient for treatment protocols according to guidelines and best practices. • 5. Clinical Practice: Patient and Family Assessment: Collects patient data for new patients using established assessment guidelines prior to initial visit to assess patient and family current and projected future needs. • 6. Clinical Practice: Patient and Family Education: Develops a patient and family education plan based on assessment findings relevant to teaching learning topics, styles, and the identification of special needs and preferences. • 7. Clinical Practice: Care Coordination and Patient and Family Referral: Interfaces with interdisciplinary team members to ensure appropriate scheduling of laboratory and diagnostic studies, procedures, and therapeutic interventions. • 8. Clinical Program Support: Collaborates with other team members to develop and implement clinical tools, protocols and guidelines relevant to new patient access and navigation; evaluates tool effectiveness and reports to team. • 9. Patient Experience: Supports the Yale team(s) in ensuring that Patient Experience standards reflect the YNHHS Mission, Vision, Values. Upholds the Standards of Professional Behavior • 10. Professional Development: Advocates for the professional nurse as a key member of the inter-professional team. Qualifications EDUCATION Bachelor's Degree in Nursing required; Master's Degree in Nursing or Healthcare preferred. EXPERIENCE A minimum of 2 years experience with patients suffering with renal disease(s), hemodialysis patients, and/or peritoneal dialysis patients in a combination of the following is preferred: inpatient or outpatient care areas, clinical process improvement, outcomes management, case management, and physician relations. SPECIAL SKILLS Candidate must be comfortable working in a fast paced, complex academic medical environment where the Nurse Navigator is a key member of the multidisciplinary team. Must possess understanding of scope of practice, clinical care delivery procedures, organizational dynamics, and process improvement processes. Must be self-motivated, goal oriented, and able to work independently. Must have the ability to develop relationships and work collaboratively and effectively in partnership with patients, families, physicians, clinical staff, hospital departments and outside organizations. Must have excellent assessment, communication and organizational skills with the ability to manage and follow through on multiple priorities. Excellent critical thinking, analysis and assessment skills for successful process improvement planning and monitoring. Proficiency in data management is ideal. YNHHS Requisition ID 182156