Senior Living Nurse Navigator - Care Coordination

• Pay or shift range: $85,000 USD to $90,000 USD
  The estimated range is the budgeted amount for this position. Final offers are based on various factors, including skill set, experience, location, qualifications and other job-related reasons.
• Travel Required : Yes

Description

Position Summary

The Health Navigator serves as the primary clinical resource and care-coordination professional for residents, promoting physical, psychosocial, spiritual, and overall wellness throughout the resident's journey, including application, move-in, transitions, hospitalization, changes in condition, and periods of crisis. This role conducts comprehensive assessments, coordinates care, removes barriers to services, supports safe transitions across the continuum of care, and collaborates with residents, families, healthcare providers, and interdisciplinary team members to achieve positive outcomes. The Health Navigator partners with campus departments, outpatient clinic providers, and community resources to enhance resident health, safety, and well-being; provides education and guidance regarding available services and care options; contributes to quality improvement and risk management initiatives; supports health and wellness programming; tracks and reports resident trends and outcomes; and serves as a key liaison in advancing person-centered care, resident choice, and operational excellence across the community.

Essential Functions

• Serve as the primary health and wellness navigator for Independent Living residents during move-in, hospitalization, rehabilitation, significant health changes, transitions, or crisis situations.
• Complete clinical and functional assessments for prospective Independent Living residents and provide recommendations regarding move-in readiness, support services, and safety needs.
• Conduct ongoing assessments of residents' physical, cognitive, psychosocial, functional, and safety needs and identify risks that may impact independent living.
• Monitor residents experiencing changes in condition and collaborate with interdisciplinary team members to develop appropriate intervention and support plans.
• Coordinate care and services across the continuum, including Independent Living, Assisted Living, Skilled Nursing, Rehabilitation, Home Health, Hospice, hospitals, and community providers.
• Facilitate safe transitions of care following hospitalization, emergency department visits, rehabilitation stays, or other significant health events to reduce risk and improve outcomes.
• Collaborate with physicians, outpatient clinic partners, rehabilitation providers, home health agencies, hospice providers, and other healthcare professionals to support resident health outcomes.
• Identify and remove barriers to healthcare access by connecting residents and families with appropriate services, resources, and support systems.
• Provide resident and family education regarding healthcare options, available services, levels of care, wellness resources, and transition planning.
• Assist residents and families with evaluating care options and making informed decisions regarding supportive services, home care, assisted living, memory care, rehabilitation, or other healthcare resources.
• Serve as a liaison among residents, families, healthcare providers, and community departments to ensure timely communication and coordinated service delivery.
• Facilitate interdisciplinary resident review meetings and maintain navigation, hospitalization, transition, and high-risk resident tracking processes.
• Document assessments, interventions, referrals, care coordination activities, resident contacts, and follow-up actions in accordance with regulatory and organizational standards.
• Identify residents at risk for falls, self-neglect, cognitive decline, medication-related concerns, social isolation, or unsafe living conditions and coordinate appropriate interventions.
• Support and promote resident health, wellness, and prevention initiatives through education, partnership development, outreach activities, and participation in quality improvement efforts.
• Conduct resident visits in health care settings as appropriate.

Education & Experience

Current licensure/ certification preferred in Social Work, Nursing, Senior Care Management, Health and Rehabilitation Sciences.

• Minimum of 3 years’ experience working with older adults within a Continuing Care Retirement Community, Assisted Living, Acute Rehab, Skilled Rehab, Nursing Home, or Hospital required.
• Experience in care coordination, discharge planning, case management, nurse liaison, navigation, resident assessment, or resident/family support preferred.
• Knowledge of aging services, chronic disease management, functional and cognitive assessment, risk identification, hospital and rehabilitation health systems, and community-based health resources.
• Ability to direct resident care and services to the elderly, which meets or exceeds Collington quality and service standards. Ability to work collaboratively with Social Work, physicians, rehabilitation providers, and interdisciplinary teams.
• Requires a valid Driver’s License, as some light travel may be required.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without reasonable accommodation. Reasonable accommodation will be determined on a case-by-case basis.

• Must be able to lift 25 lbs. from the floor to waist.
• Able to transport a resident in a wheelchair.
• Able to kneel, bend from waist to floor, stoop, twist torso laterally in all directions and grasp small and large objects.
• Ability to drive from Collington to partner Skilled Nursing Facilities, as well as Hospitals and Assisted Living facilities within a 40-mile radius.

We also offer the following benefits:
- A comprehensive Medical, Dental, Vision, Life & Disability Plans
- 403 (b) Tax-Deferred Retirement Savings Plan
- Vacation, Sick Leave, Birthday & Holiday Pay
- Employee Assistance Program
- Scholarship opportunities

Salary: Up to $90,000/year based on experience.

Travel Required

Yes .

Qualifications

Skills

Preferred

Microsoft Word

Novice

Microsoft PowerPoint

Intermediate

Microsoft Excel

Intermediate

Behaviors

Required

Enthusiastic

: Shows intense and eager enjoyment and interest

Team Player

Team Player

: Works well as a member of a group

Detail Oriented

Detail Oriented

: Capable of carrying out a given task with all details necessary to get the task done well

Motivations

Preferred

Goal Completion

Goal Completion

: Inspired to perform well by the completion of tasks

Flexibility

Flexibility

: Inspired to perform well when granted the ability to set your own schedule and goals

Ability to Make an Impact

Ability to Make an Impact

: Inspired to perform well by the ability to contribute to the success of a project or the organization

Experience

Preferred

Minimum of 3 years’ experience working with older adults within a Continuing Care Retirement Community, Assisted Living, Nursing Home, or Hospital required.

Licenses & Certifications

Required

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.

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