Job Description

Summary of Essential Duties: Job Summary:

Responsible for the coordination of care for patients throughout the continuum of treatment; from initial referral to follow-up care, serving as a consistent contact, or point person for the high-risk patient. Collaborates and operates as a member of the interdisciplinary team, serving as a patient advocate throughout the patient care process. Provides necessary education and information on available options, the informed decision-making process, and realistic goal setting in order to empower the patient/caregiver to actively participate in their plan of care. Establish and coordinate a supportive care plan with goals and interventions based upon treatment and individual patient/caregiver needs, preferences, beliefs and values. Keeps patient/caregiver involved in plan and moving toward self-directed care. Review, evaluate and revise the plan of care for appropriateness on an ongoing and timely basis. Be an advocate for the patient/caregiver. Participates in the development of guidelines, protocols, pathways, and other performance improvement activities as it relates to patient care. Works in concert with the Patient Advisory Council to coordinate, implement, and evaluate educational programs/projects for patients and the community at large.

Reporting to the Executive Director, the nurse navigator will be responsible for the growth of the programs associated with areas of responsibility and assurance of excellent patient and family centered care as well as continuity of care.

Responsibilities

Summary of Essential Duties:
Job Summary:

Responsible for the coordination of care for patients throughout the continuum of treatment; from initial referral to follow-up care, serving as a consistent contact, or point person for the high-risk patient. Collaborates and operates as a member of the interdisciplinary team, serving as a patient advocate throughout the patient care process. Provides necessary education and information on available options, the informed decision-making process, and realistic goal setting in order to empower the patient/caregiver to actively participate in their plan of care. Establish and coordinate a supportive care plan with goals and interventions based upon treatment and individual patient/caregiver needs, preferences, beliefs and values. Keeps patient/caregiver involved in plan and moving toward self-directed care. Review, evaluate and revise the plan of care for appropriateness on an ongoing and timely basis. Be an advocate for the patient/caregiver. Participates in the development of guidelines, protocols, pathways, and other performance improvement activities as it relates to patient care. Works in concert with the Patient Advisory Council to coordinate, implement, and evaluate educational programs/projects for patients and the community at large.

Reporting to the Executive Director, the nurse navigator will be responsible for the growth of the programs associated with areas of responsibility and assurance of excellent patient and family centered care as well as continuity of care.
Primary Duties and Responsibilities:

• Establishes and revises the plan of care for appropriateness on an on-going and timely basis as directed by the patient's care team. Assists in the development of a comprehensive diagnostic/treatment plan related to the patient's needs, through interdisciplinary input and attendance at weekly meetings.
• Coordinates patient care activities and management of clinical data throughout all phases of patient care from initial referral to follow-up. Arranges for clinical services, evaluates clinical data, participates in clinical/ patient rounds, and triages clinical questions/ concerns to the appropriate members of the interdisciplinary team.
• Develops, coordinates, implements and evaluates educational programs/ projects for patients/caregivers, nursing staff and assigned members of the support staff. Serves as a preceptor for other coordinators. Provides educational sessions for patients/caregivers and other clinical staff throughout the Medical Center as appropriate.
• Demonstrates clinical competence in the assessment and intervention for patient, family, or significant other requiring emotional support, coping support and care for significant life changes. Coordinates support services within the health system and community to meet patient/family needs.
• Provides leadership in developing standards of care for patients undergoing new therapies, demonstrates knowledge and follows the approved protocol for specialized nursing care.
• Tracks volume of referrals and transports, measures outcomes. Actively works to increase in the number of outpatient and inpatient referrals, procedures, and patient participation in various clinical and research programs and outreach activities.
• Consults with physicians and other health care professionals as indicated regarding patient care issues and quality of care issues related to patients. Supports the leadership and clinical teams by providing progress reports on patient care, local partnerships, and other quality measures. Actively participates in quality improvement measures and projects as requested and directed. Recommends, develops, and implements policy/protocol revisions and performance improvement activities based on current standards.
• Utilizes a systematic approach to assess educational needs in collaboration with all levels of nursing and medical personnel and evaluates the effectiveness and efficiency of educational programs. Collaborates throughout the Cedars-Sinai Health system (CSHS) in initiating and implementing educational programs.
• Independently coordinates patient programs, projects and events with Nursing, medical center departments and communities across the health care continuum. Serves as a resource and consultant for educational programs throughout the Cedars-Sinai Health System.
• Establishes, coordinates and continuously evaluates supportive care plan with goals and interventions based upon treatment and individual patient/caregiver needs, preferences, beliefs and values.
• Promotes/ facilitates research by facilitating inter and intra-departmental research, promoting collaborative research and utilizing education and clinical research findings to design/ revise education programs throughout the Cedars-Sinai Health System.
• Actively works to create new transfer agreements with local hospitals, works to build new referral relationships with key physician groups and hospitals in Southern California.
• Coordinates and collaborates with other Nurse Navigators in various divisions and departments to effectively coordinate care of all identified patients.
• May represent the Medical Center at regional and national meetings/conferences.
• Performs all other duties as assigned.

Cancer Center

• Call new patients in advance of their consult, see them at consult, provide support, education, ensure referrals are done (i.e. radiation), see patient on first day of their chemo and call them 24-48 hours after their first chemo.
• Hand-off to the practice RN who follows them throughout their continuum of care.
• Provide referrals to nutrition, social work and attend weekly interdisciplinary meetings.

Qualifications

Qualifications:

Education:

• Bachelor of Science in Nursing required

License/Certification:

• Current, unrestricted California RN license required
• Professional Certification in area of specialty required within one (1) year of hire

Experience:

• A minimum of 3 years of nursing experience in an acute care setting (transplant, cancer)
• Experience with program development and implementation of navigator programs preferred