Nurse Navigator - Dialysis

Essential Functions

• Patient Care and Coordination Actively engages with the patient/family and medical team utilizing evidence-based practice to assess needs as it relates to diagnoses, care coordination, follow up, and to establish expectations of care delivery with family Reassesses needs and provides appropriate interventions. Monitors and evaluates patient status Maintains up to date information regarding the patient-specific plan of care and status Leads and participates in multidisciplinary conferences ensuring communication amongst all team members and families to access appropriate healthcare resources Communication between inpatient, outpatient and home setting including internal and external healthcare providers, personnel, and/or community agencies to coordinate services and assist with continuity of care Completes follow up on patients/families post medical care and as needed to decrease re-admissions, ED utilization, and adherence to medical care Understands, communicates, and collaborates with team members regarding reimbursement strategies as necessary to coordinate care relating to regulatory requirements and benefits management (Utilization management, authorizations team etc) Identifies and implements plans for high-risk patients who are not meeting goals or are high risk for not meeting goals. Acts as clinic RN for patient population
• Education Leads in area of expertise, patient support groups, community resources, programs, events, and activities for families to participate in and receive additional support from in the community. Works in conjunction with the care team to provide education to patients and families to meet goals of care Acts as the family liaison to ensure understanding of plan of care and to provide support in the decision-making process by empowering parents to learn and care for their child at home Responsible for developing and maintaining patient-family education resources related to the patient population Serves as a resource for the clinical care team.
• Program Development, Accreditation and Leadership Serves as the subject matter expert for the patient population Identifies and implements best practices, innovations, research, relevant trends, and performance improvement opportunities. Must complete one performance improvement project annually Participates in development, translation, and implementation of patient population specific activities to achieve optimum service delivery/systems/care processes Responsible for evidence-based care and participating in creating new policies, protocols, and educational resources Monitors and meets patient population specific metrics (registry, dashboard, and KPIs) Reports metrics quarterly to division leadership and establishes goals to meet and improve outcomes Ensures program meets or exceeds requirements that are defined by accreditation, US News and World Report, and/or other relevant metrics (i.e. DHHS, TJC, CMS, etc.). Responsible for leading accreditation process and meeting requirements Executes educational opportunities via newsletter article, annual conference, CME/CNE opportunities Participates in community outreach or marketing projects to develop a strong relationship with community and referring physicians Collaborates with leadership and key stakeholders to develop, implement, and evaluate clinical services with an emphasis on coordination across the continuum of care and a goal of aligning healthcare services around the needs of the patient population
• Performs other duties as assigned including covering additional clinic needs as identified by department leadership
• Perform physical requirements as described in the Physical Requirements section

Education Qualifications

• Bachelor's Degree from an accredited college or university in Nursing Required

Experience Qualifications

• Minimum 5 years in nursing, preferably in pediatric setting Required

Skills and Abilities

• Demonstrated written and verbal communication skills.
• Ability to apply the nursing process to acute patient care to achieve outcomes.
• Current knowledge of the healthcare environment, including community resources and financial systems.
• Working knowledge of basic computer programs such as word, excel. Knowledge of smart phone use.

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure in the State of Nebraska Required and
• Health Services\BCLS - Basic Life Support through the American Heart Association Required

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