Nurse Navigator - Community Care Center

Capital Markets Placement; Connecticut; On-site; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization in Connecticut is seeking a Community Care Nurse Navigator to enhance patient care and transition management. This role involves working with an interprofessional team to reduce readmissions and improve healthcare access for vulnerable populations. Candidates should have a Bachelor's degree in nursing, a current Connecticut Nursing License, and at least five years of nursing experience. The position offers competitive benefits and opportunities for professional growth.

Benefits

Competitive benefits package

Opportunities for growth

Qualifications

• Minimum five years of nursing experience, inpatient and ambulatory preferred.
• Current Connecticut Nursing License required.
• BLS Certification is mandatory.

Responsibilities

• Assist patients transitioning from acute care to improve care coordination.
• Perform post-discharge care including education and medication reconciliation.
• Document all communications and plans in EPIC.

Skills

Patient Education

Care Coordination

Advocacy

Education

Bachelor's Degree

MSN (preferred)

Job description

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Location Detail: 132 Jefferson St Hartford (10483)

Shift Detail: Monday through Friday, 8a - 430p

Work where every moment matters.

Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

Hartford Hospital is one of the largest and most respected teaching hospitals in New England. We are a Level 1 Trauma Center providing cutting-edge treatment. This is supported by the largest robotic surgery center in the Northeast and the Center for Education, Simulation and Innovation (CESI), one of the most advanced medical simulation training centers globally. When hospitals cannot provide the advanced care, expertise, and new treatment options patients require, they turn to us.

The Community Care Clinic (CCC) is located at 132 Jefferson St on the third floor of the Hartford Hospital Community Health building. CCC has close to 3,000 patient visits annually, averaging 50 patients per day. The Division of Infectious Diseases offers inpatient and outpatient consultation for various infectious diseases, supported by state-of-the-art diagnostic laboratories. Our team includes providers, psychiatry staff, fellows, residents, social workers, nutritionists, pharmacy liaison, APRNs, RNs, MAs/MAAs, a Case Manager, and a Data Manager, all committed to compassionate care, teaching, and research. CCC is Ryan White funded, with 75% bilingual (primarily Spanish), and 80% of patients covered by Medicaid. Our specialists treat conditions like HIV, Hepatitis, fevers of unknown origin, recurrent infections, influenza, opportunistic infections, and more. CCC guides patients through the healthcare system, including referrals to other providers.

Job Summary: The Community Care Nurse Navigator, functioning within the professional nursing framework, is an experienced registered nurse focused on patient throughput, transitional care gap prevention, and issue resolution to improve health outcomes and equitable care. Supporting the HHC mission, this role provides skilled nursing care in various clinical settings, using the nursing process to assess, plan, intervene, and evaluate human responses to health problems, following established standards and guidelines. Reports to a Practice Manager.

Job Responsibilities:

• Act as part of an interprofessional team to assist patients transitioning from acute care, aiming to reduce readmissions and inappropriate ED use, improve care coordination, and enhance access for vulnerable populations. Educate the community and advocate for resources to promote healthcare engagement and collaboration among providers.
• Partner with inpatient or ED physicians and care teams to identify transition gaps and establish safe transition plans, including scheduling, medication plans, diagnostics, education, and home care planning.
• Perform post-discharge care within 24-48 hours, including calls, education, symptom management, and medication reconciliation, collaborating with care teams to address gaps.
• Follow up on diagnostics, collaborate with homecare, pharmacy, and DME providers, and ensure necessary resources are in place, including authorizations and appointments.
• Work with clinic physicians to resolve issues and establish primary care providers for patients, facilitating transfers as needed.
• Document all communications and plans in EPIC.
• Complete transitional care strategies per CMS/Payer guidelines.
• Build rapport with patients and advocate for their needs.
• Work independently and as part of the team to ensure safe, efficient care, providing peer support and patient education.
• Participate in care team meetings to develop and implement safe transition plans and process improvements.
• Apply nursing processes within organizational frameworks and guidelines.
• Provide office-based nursing care in collaboration with providers, communicating assessments and recommendations effectively.

This is a grant-funded position.

Qualifications:

• Bachelor's Degree required, MSN preferred
• Minimum five (5) years of nursing experience, inpatient and ambulatory preferred
• Current Connecticut Nursing License
• BLS Certification
• Obtain CCM/CCCTM certification within two years of hire

We take great care of careers. Hartford HealthCare offers opportunities for growth, innovative technologies, breakthrough treatments, and community education. We provide a competitive benefits package to support work/life balance. Every moment matters. This is your moment.

As an Equal Opportunity Employer/Affirmative Action employer, the organization does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.