Nurse Navigator, Oncology

Job Requirements

Company Description

At Shore Regional Health, you can learn, grow and make a lasting impact on patients and families. You’ll experience the support of a collaborative work environment and a sense of collegiality unlike any other. Our comprehensive system has many locations and practice options to choose from throughout the beautiful Eastern Shore of Maryland.

As a Nurse At UMMS, You’ll Experience

• A supportive and collaborative work environment
• An Achievable Professional Advancement Model: Opportunities to progress in function, skills, and pay through our achievable promotion schedule.
• The opportunity to work in a specialized care environment at an Academic Medical Center with a nursing-centered care model and Magnet Designation.
• A comprehensive benefits package including health, vision, and dental coverage including prescription drug coverage, Tax-Free Savings Plans, and more!
• A competitive wage scale: Annual merit increases and a base wage scale that is measured against market standards.
  
  

Job Summary

• Identifies high risk patients through use of prospective risk stratification tool (e.g., high risk diagnosis, START, LACE, etc.)
• Completes comprehensive psycho-social assessments, consultation, treatment, and discharge recommendations, to include remote patient monitoring
• Provides complex care planning to high-risk patients in the community, via telephone calls, in-person meetings, telehealth, etc., according to established program protocols and policies
• Accepts responsibility for patients’ Transitions of Care, coordinating provisions for discharge from facilities including follow-up appointments, home health, community services, transportation, etc., in order to maintain continuity of care
• Coordinates and facilitates communications between all patient settings, including acute care, ambulatory, short stay, skilled nursing, palliative care, and hospice
• Promotes patient self-management, educating patients on disease specific needs, medication, access to care, self-care support, to improve clinical outcomes and increase patient self-efficacy
• Identifies pts needs and makes appropriate referrals to programs/services (i.e. social worker, pharmacist, community agencies, etc.)
• Consults regularly with the inpatient team, PCP, supervisor, transitional team, and other team members to ensure that the transition plan remains relevant, appropriate, and achievable to changing patient status and/or goals
• Meets with patients while in the hospital to establish rapport and smooth transition to outpatient setting and follow-up
• Maintains effective relationships with patients and families, community-based agencies, and payers, facilitating interdisciplinary team meetings
• Collaborates and implements plans in accordance with established policies, prioritizing patient care goals and needs. Meeting with patients, patients’ family and caregivers as needed to discuss transitional care and treatment plan
• Works proactively with patients, caregivers, and patients care team to identify an advanced care plan, including Advanced Directives and MOLST
• Implements plan of care for the patient by performing evidence-based interventions and treatments specific to the diagnosis or problem of the patient; administers treatment such as, lab draws, start IVs, injections, nebulizer treatments, wound care as directed by provider, and monitors patients according to their needs and acuity level. Performs symptom-based standing orders and plan of care
• Maintains accurate and complete records, initiates and oversees data entry into IT systems, documents all care rendered, pertinent patient information, all communications, and all care management decisions in appropriate database/electronic record
• Takes the lead on programs, identifying improvements and putting changes in place to better assist the high-risk population. Provides education to the team on information that will benefit patient outcomes
• Perform all other duties as assigned.
  
  

Work Experience

Education & Experience - Required

• Associate Degree in Nursing required
• Minimum three (3) years of previous nursing experience required
• One (1) year previous case management experience
• Current Maryland RN license required
• BLS required
  
  

Education & Experience - Preferred

• Experience with quality-based reimbursement models, utilization management, or outpatient medical practice preferred
• Bachelor of Science in Nursing preferred
  
  

Compensation

Benefits

• Pay Range: $40.61-$60.96
• Other Compensation (if applicable):
• Any applicable shift differentials
• UMMS Benefits Guide
  
  

All your information will be kept confidential according to EEO guidelines.