Nurse Navigator

WVU Medicine; United States; On-site; USD 70,000 - 90,000; Full time

Job summary

PVH Potomac Valley Hospital is seeking a registered nurse navigator to triage patient calls, assess needs, and coordinate referrals across clinic, e-visit, and telehealth options. The role emphasizes education on immediate care and preventive behaviors, while documenting interactions to support a comprehensive medical record.

The position requires an active nursing license, BLS, and a minimum of three years of nursing experience, with BSN preferred.

Qualifications

• Current RN license with WV Board or eNLC
• BLS certification required within 30 days of hire
• 3 years nursing experience required
• BSN preferred
• Care coordination experience preferred
• Five years nursing experience preferred

Responsibilities

• Assess caller needs using established criteria and document thoroughly
• Provide callers with medical information using established resources
• Identify gaps in care and intervene
• Facilitate referrals by scheduling clinic appointments, e-visits, or telehealth
• Assist patients in selecting physicians and facilities to improve access and reduce costs
• Educate patients and coach on treatment options for informed decisions
• Determine urgency of healthcare needs and disposition via telephone
• Maintain comprehensive medical records of all patient conversations
• Collaborate with Case Management and Community Health Workers for safe transitions
• Handle ambulatory utilization and quality screening for assigned patients
• Stratify risk to prioritize needs and direct interventions
• Design individualized care plans coordinating services
• Participate in clinical performance improvement and data-driven decisions
• Monitor laboratory/diagnostic results and utilization for quality and efficiency
• Collaborate with leadership for process improvements and best practices
• Educate multi-disciplinary teams on clinical pathways and managed care principles

Skills

Communication skills

Nursing

Clinical assessment

Education coaching

Education

RN license (State board)

BSN (preferred)

BLS certification within 30 days

Tools

Electronic Health Records (EHR)

Care coordination software

Job description

This position collaborates with patients and primary care providers to ensure patients receive quality, efficient, and cost-effective healthcare services. Responsible for triaging incoming patient calls, assessing needs, giving appropriate clinical dispositions and facilitating referrals. This position will educate the patient when appropriate regarding immediate care advice and preventative behaviors.

MINIMUM QUALIFICATIONS** : **

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Current unencumbered licensure with the WV Board of Registered Professional Nurses, or appropriate state board where services will be provided, as a registered professional nurse OR current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).

2. Obtain certification in Basic Life Support within 30 days of hire date.

EXPERIENCE:

1.Three (3) years of nursing experience.

PREFERRED QUALIFICATIONS** : **

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor of Science in Nursing (BSN).

EXPERIENCE:

1. Preferred prior care coordination experience.

2. Five (5) years of nursing experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Professional assessment of callers needs using established criteria and protocols while performing accurate, concise and timely documentation.

2. Use established software, online resources, written materials and nursing background to provide callers with appropriate medical information.

3. Identifies problems or gaps in care offering opportunity for intervention.

4. Facilitates referrals within our clinics by scheduling and coordinating either a clinic appointment, e-visit or telehealth visit with a provider.

5. Supports consumers in selection of best physician and facility to maximize access, quality, and manage healthcare cost.

6. Provides health education and coaches consumers on treatment alternatives to assist them in best- decision making.

7. Identifies the nature and urgency of patient’s healthcare needs and determine appropriate disposition via telephone.

8. Documents all conversations with patients with patients to maintain a comprehensive medical record.

9. Supports team environment which allows clear communication, positive support and creative thinking.

10. Communicates with Case management, Community Health Workers, patients, families, and physicians/providers to assist in safe transition of care.

11. Ambulatory Utilization Management, Financial management and Quality Screening for assigned patients.

12. Identifies the targeted population and risk stratifies patients to prioritize needs and direct interventions.

13. Works collaboratively with patients to design an individualized plan of care that ensures coordination of services by the healthcare team.

14. Clinical performance improvement, outcome management and quality activities.

15. Uses data to drive decisions and plan/implement performance improvement strategies for assigned patients, including fiscal, clinical and patient satisfaction data.

16. Implements clinical interventions based on risk stratification and evidence based clinical guideline adherence and promotes best practice by initiating/adjusting therapies as directed by the practitioner and providing appropriate follow-up monitoring as needed.

17. Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency results for assigned population.

18. Monitors clinical and financial indicators on an ongoing basis and takes action to achieve continuous improvement in both areas.

19. Works with leadership to continuously evaluate process, identify problems, and propose process improvement strategies.

20. Educates multidisciplinary team and physicians about clinical pathways/protocols and managed care principles.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping are necessary body movements utilized in performing duties through the work shift.

2. Ability to sit for long periods of time.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.Office/call center setting environment.

SKILLS AND ABILITIES:

1. Must be flexible in fast past and rapidly changing environment.

2. Excellent oral and written communication skills, as well as motivated and organized with handling and maintain confidential information.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

PVH Potomac Valley Hospital

Cost Center:

8880 PVH Medicine Preventive Medicine

Address:

100 Pin Oak Lane

Keyser

West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively “WVUHS”) is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.