Care Continuum Navigator

Vanderbilt Health; United States; On-site; USD 70,000 - 95,000; Full time

Job summary

Vanderbilt Health is seeking an experienced case management leader to actively guide complex patient care across the continuum. You will collaborate with clinical teams, community resources, and families to remove barriers and secure appropriate follow-up and services.

In this role you will oversee post-acute communications, triage needs, and coordinate transitions to the proper level of care. You will serve as a key liaison, improving outcomes while supporting patients and their families

Qualifications

• Access Patient Education (Advanced): Demonstrates mastery of patient education across care continuum.
• Patient Assessment & Evaluation (Advanced): Conducts patient interviews and assessments in complex situations.
• Evidence-Based Practice (Advanced): Applies research to improve care in challenging cases.
• Case Management (Advanced): Leads coordination across providers and settings.
• Treatment Planning (Advanced): Develops and adjusts patient care plans.

Responsibilities

• Leads patient progress through care continuum with outcomes-based practice and manages communications between providers, facilities, families, and transport.
• Manages post-acute care hotline, triages calls, and coordinates deployment of clinical resources.
• Transitions patients to appropriate care levels and arranges outpatient follow-up.
• Acts as primary customer service rep for post-acute services within the network and conducts outreach.
• Collaborates with legal conservators in patient care decisions.

Skills

Access Patient Education

Patient Assessment

Evidence-Based Practice

Case Management

Treatment Planning

Job description

Vanderbilt Health is seeking an experienced case management leader to actively guide complex patient care across the continuum. You will collaborate with clinical teams, community resources, and families to remove barriers and secure appropriate follow-up and services.

In this role you will oversee post-acute communications, triage needs, and coordinate transitions to the proper level of care. You will serve as a key liaison, improving outcomes while supporting patients and their families