RN Navigator

Mosaic-Community-Healt; Bend (OR); On-site; USD 85,000 - 110,000; Full time

Job summary

Mosaic Community Health is seeking an RN Navigator to provide clinical navigation and care coordination across the ambulatory continuum. The RN Navigator acts as a consistent contact and uses the nursing process to deliver protocol-driven guidance, risk-stratified follow-up, and seamless transitions among primary care, specialists, EDs, and community services.

The role focuses on high-risk patient follow-up and coordination with internal and external partners to ensure timely follow-up and

Qualifications

• Superior nursing process skills.
• Strong critical thinking and problem solving.
• Excellent written, verbal and interpersonal communication.
• Telephone and patient interaction experience.
• Basic typing and Windows computer skills.
• Spanish fluency preferred.
• EPIC EHR experience preferred.

Responsibilities

• Coordinate care of complex and high-risk patients using evidence-based practice.
• Support patient care needs with external partners for seamless transitions among primary care, specialty providers, and community services.
• Manage urgent and complex referrals with timely follow-up.
• High-risk laboratory and diagnostic follow-up and coordination of interventions.
• ED follow-up to support safe transitions and continuity of care.
• Coordinate care needs for patients/caregivers in community settings (e.g., ALFs, SNFs, foster homes).
• Educate patients and families on chronic disease management and preventive health behaviors.
• Utilize standing orders to manage patient care.
• Perform patient outreach and follow-up as directed.
• Document interactions in the EHR timely and accurately.
• Provide Population-Specific Navigation for adults and pediatrics.
• Maintain documentation aligned to nursing practice and regulatory requirements.

Skills

Nursing process

Critical thinking

Communication skills

Telephone interaction

Windows skills

Education

Associate degree in Nursing

BSN (preferred)

Tools

EPIC EHR

Job description

• Remote
• Nurses
• Full-Time
• Requisition #: RNNAV003295

Description

Candidates must live in Central Oregon

The RN Navigator is a registered nurse who provides clinical navigation and care coordination for patients across Mosaic’s ambulatory continuum. Serving as a consistent point of contact, the RN Navigator utilizes the nursing process to deliver protocol‑driven guidance, risk‑stratified follow‑up, and seamless transitions among primary care, specialty partners, emergency departments, and community services. The RN Navigator role is focused on high-risk patient follow-up and complex care coordination utilizing the nursing process. This role plays a critical part in ensuring seamless communication, timely follow-up, and effective navigation of care for high-risk patients with complex needs. The RN Navigator acts as a resource for urgent and complex referrals, coordinates with both internal and external partners, and supports high-risk laboratory and diagnostic follow-up.

Responsibilities

• Coordinate the care of complex and high-risk patients using evidence‑based practice.
• Support patient care needs with external partners, to deliver seamless transitions among primary care, specialty providers, and other community services.
• Provide and support urgent and complex referral management, facilitating timely and appropriate patient care.
• Provide high‑risk laboratory and diagnostic follow‑up, ensuring prompt action on abnormal results and coordinating necessary interventions.
• Perform emergency department (ED) follow‑up, contacting patients based on risk stratification to support safe transitions and continuity of care.
• Coordinate care needs for patients and/or caregivers in community settings (examples: ALFs, SNFs, foster homes, residential treatment facilities.)
• Provide patient and family member education on chronic disease management, acute conditions, and preventive health behaviors.
• Utilize standing orders to manage the care of patients.
• Perform patient outreach and/or follow‑up as directed.
• Provide patient care within scope of nursing practice and current competencies, including telephone triage.
• Document all interactions in the EHR in a timely, thorough, and accurate manner
• Provide Population‑Specific Navigation (as assigned) – adult and pediatrics.
• Maintain accurate, timely documentation aligned to nursing practice models, policies, and regulatory requirements.

Work Experience:

Minimum two years of RN clinical experience in acute or ambulatory care preferred. Care coordination experience in an ambulatory setting preferred. Experience working with pediatric patients preferred

Education, certification and licensure

• Preferred: Bachelor of Science in Nursing (BSN)

Skills & Knowledge

• Required: Superior nursing process skills. Critical thinking and problem‑solving skills. Excellent written, verbal, telephone and interpersonal communication skills. Familiarity/experience with client interaction on the telephone. Knowledge of community resources. Basic typing and computer skills and comfort with Microsoft Windows operating system.
• Preferred: EHR experience - EPIC experience a plus. Fluency in Spanish preferred. Involvement with quality improvement processes. Knowledge of health insurance plans, standard office policies and procedures as well as regulatory requirements including CLIA and OSHA standards.

Who We Are

Mosaic Community Health prides itself on being an innovative health system that pioneers unique and creative ways to provide and improve patient access to health care. Since our founding in 2002 we have proudly served insured and uninsured patients regardless of age, ethnicity, or income.

We focus on a holistic approach to patient care by incorporating behavioral health, pharmacy, and nutrition support to serve patients in the most meaningful way. At Mosaic Community Health, you will work with incredibly dedicated and mission‑centered peers and be part of a dynamic team based environment.

Mosaic Community Health offers more than just a job, it is a lifestyle. A lifestyle of serving others. A lifestyle of being an integral part of your community. A lifestyle that offers work/life balance. A lifestyle of enjoying the outdoors! Central Oregon offers over 300 days of sunshine a year, so enjoy a PTO day on the mountain, biking/hiking trails, or the river! A lifestyle that improves lives, including yours. Of course, we also offer a great benefit package!

Qualifications

Education

Required

Associates or better in Nursing.

Licenses & Certifications

Required

CPR

Driver's License

Registered Nurse

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.