Nurse Navigator - Renal Care

Overview

• Coordinates and navigates care for patients diagnosed with renal issues through the continuum of care from referral or diagnosis
• through treatment and survivorship.
• Assures high quality, comprehensive care for patients consistent with CMS guidelines and principles of achieving good clinical patient outcomes. Facilitates the transition of patients from inpatient to outpatient and vice versa throughout all phases of care.
• Serves as a care coordinator for the multi-disciplinary team. Plans, reviews, establishes, and implements procedures to insure the proper communication between Capital Health staff, physicians, and community resources.

Responsibilities

• Initiates communication with patient upon diagnosis and Nephrology referral. Collaborate with physicians to ensure efficient
• quality care for all patients.
• Develops an educational tool kit on renal therapy including information on home hemodialysis, peritoneal dialysis, and kidney   transplant. Develops CKD and modality education implementation for patients, care givers, and support systems.
• Assumes the role of the Vascular Access Manager. Initiates, monitors, coordinates, and follows up on all patients’ vascular access plans.
• Assesses new patients’ medical, emotional, social, educational, psychosocial, and cultural needs and develops an individualplan of care based on these needs within the first ninety days.
• Provides and reinforces education with patients and their care partners about the diagnosis and all treatment options based on their individual needs and learning styles.
• Serves to enhance the patient's quality of life, sense of autonomy, and self-determination for managing own health.
• Provides and connects patients with information about resources in the community. Functions as patient liaison, performsclinical rounds on inpatients, and acts as the hospital contact for all new patients.
• Coordinates patient appointments for consultations and provide symptom management services. Follows up and assists indischarge planning with patients, family, and renal care team.
• Maintains a database to track patient demographics and treatments, navigation activities, quality and performance metrics, patient flow, and turnaround time from diagnosis to treatment.
• Conducts renal therapy awareness programs for existing patients, staff, and the community. Takes initiative and action to remove admission barriers. Collaborates with management to improve patient retention. Escalates admission barriers to Medical Director.
• Plans and educates at several yearly community education events.
• Maintains constant readiness for system-wide DNV-GL/DHSS/CMS surveys and inspections as measured by self-assessment against standards.
• Collaborates with social workers, dieticians, and clinical nurse specialists.

Requirements

• Bachelor’s degree in nursing required. Must attain MSN within four years of hire date.
• Three years previous patient care experience as a nurse.
• Operational supervision experience in a hospital inpatient and outpatient setting preferred.
• Experience with policy development and implementing evidence-based practice preferred.
• Intermediate computer skills. Experience with Microsoft Office.
• NJ RN License

• Frequent physical demands include:
• Occasional physical demands include: Sitting , Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull ,
• Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor
• activities , Keyboard use/repetitive motion , Taste or Smell , Talk or Hear
• Continuous physical demands include:
• Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.

Our Network

Offers are contingent upon successful completion of our onboarding process and pre-employment physical.  Capital Health will require all applicants (including contractors, travelers and consultants) to have an annual flu vaccine, with the exception of individuals with medical and religious exemptions.

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