Nurse Navigator

Henrietta Johnson Medical Center; Wilmington (DE); On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Health Insurance

Long-Term Disability

Employee Assistance Program (EAP)

Short-Term Disability Option

Job summary

Henrietta Johnson Medical Center in Delaware is seeking a Nurse Navigator to guide patients through the healthcare system and coordinate services across the care continuum.

The role emphasizes value-based care, reduces fragmentation, and strengthens follow-up for high-risk or medically complex populations.

Applicants should hold an RN license, have 3–5 years of relevant experience, and be proficient in care coordination and documentation.

Qualifications

• Current, unrestricted RN license in Delaware or compact state
• 3–5 years in nursing, care coordination, utilization management, or case management
• Strong knowledge of referral management and transitions of care

Responsibilities

• Coordinate referrals, appointments, diagnostics, and care plans for assigned patients.
• Assess barriers to care across clinical, behavioral, and social domains with the care team.
• Track patient progress and follow-up milestones to reduce gaps and unnecessary utilization.
• Educate patients on diagnoses, treatment plans, medications, and follow-up steps.
• Collaborate with providers, nurses, case managers, and community partners to ensure continuity of care.
• Document navigation activities and care plans in the electronic health record timely.
• Support quality and value-based initiatives tied to transitions of care and outcomes.
• Maintain confidentiality and report privacy or security concerns per policy.

Skills

Care coordination

Documentation in EHR

Interdisciplinary collaboration

Clinical knowledge

Job description

About This Role

The Nurse Navigator guides patients through the healthcare system and coordinates services across the continuum of care. The role advances value-based care by reducing fragmentation, supporting timely follow-up, reinforcing treatment plans, and improving patient experience and outcomes for high-risk or medically complex populations.

What You’ll Do

• Coordinates referrals, specialty appointments, diagnostics, hospital follow-up, and plan-of-care activities for assigned patients.
• Assesses clinical, behavioral, and social barriers to care and works with interdisciplinary teams to address identified needs.
• Tracks patient progress and follow-up milestones to reduce care gaps, missed transitions, and unnecessary utilization.
• Provides education regarding diagnoses, treatment plans, medications, referral processes, and follow-up expectations.
• Partners with providers, nurses, case managers, behavioral health staff, community health workers, and external organizations to improve continuity of care.
• Documents navigation activities, risk issues, care plans, and communication in the electronic health record in a timely manner.
• Supports quality, utilization-management, and value-based performance initiatives tied to transitions of care and chronic condition outcomes.
• Maintains confidentiality and reports suspected privacy or security concerns according to policy.

What You Bring

• Current unrestricted Registered Nurse license in the State of Delaware, or compact state authorization as applicable.
• Three to five years of nursing, care coordination, utilization management, or case management experience.
• Strong knowledge of referral management, transitions of care, and patient education principles.
• Ability to manage multiple priorities and document accurately in the electronic health record.

Preferred Qualifications

• Experience in an FQHC, oncology, specialty coordination, or complex care management setting.
• Case management certification or equivalent training.
• Experience supporting value-based contracts or population health initiatives.

This Role Is Grant-Funded

This position is funded through Delaware's federal Rural Health Transformation Program grant, awarded through the Delaware Department of Health and Social Services. Although the RHT award covers a five-year project period, funding is approved and allocated annually, and continued employment in this role is contingent on annual grant reapproval.

Compensation and Benefits

This role offers a competitive salary based on experience and community health center pay standards in Delaware.

• Health Insurance (Medical / Dental / Vision)
• Long-Term Disability
• Employee Assistance Program (EAP)
• Short-Term Disability Option

Equal Opportunity Employer

Henrietta Johnson Medical Center is an equal opportunity employer.

Questions About This Role

Contact [e-mail] or [e-mail].