Care Coordinator RN Nurse Navigator

Care Coordinator RN Nurse Navigator

Join the Cleveland Clinic West Palm Beach team where you will work alongside passionate caregivers and provide patient-first healthcare. You will work alongside dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

As a Care Coordinator RN Nurse Navigator, you will collaborate with Emergency Department physicians and a multidisciplinary care team to coordinate care for high-risk patients across the continuum of care. In this role, you will support ED provider-led patient management by conducting patient outreach, facilitating care coordination, and providing longitudinal disease management for patients with chronic conditions or episodic healthcare needs. You will work to ensure seamless transitions of care, promote wellness, reduce preventable emergency department visits and hospital readmissions, and enhance patient satisfaction through timely communication and coordination with patients, providers, and community resources.

A caregiver in this role works days from 8:00 a.m. to 5:00 p.m., with weekend, holiday and on-call requirements.

A caregiver who excels in this role will:

• Work collaboratively with a multidisciplinary care team across the continuum of care for high-risk patients to develop goals, plan interventions and maximize patient outcomes.
• Provide care and disease management coordination.
• Identify patients in the specialty care practice that have ongoing coordination needs and conduct targeted outreach.
• Outline the nature and duration of involvement needed by the specialty care team and specialty care coordinator and identify the primary care team involved.
• Utilize assessment skills and risk assessment tools to identify patients with actual or potential care needs that would require care coordination.
• Utilize technological tools (registries, patient lists, care team tab, etc.) to manage populations.
• Conduct comprehensive clinical assessments that include disease-specific, age-specific, medical, behavioral, pharmacy, social and end of life needs of each patient.
• Inform and work with patients and their families regarding coordination of their care, provide education and coaching, monitor patient compliance with their care plan, perform reassessments regarding patient progress toward goals and update plan of care.
• Serve as a liaison and advocate for patients and families.
• Assist in managing transitions of care across care settings, ensuring optimal communication and planning.
• Identify barriers, facilitate solutions and connect others to community resources.
• Partner with other care coordinator teams such as primary and transitional care social work, rehabilitation, pharmacy, palliative care and others.
• Define and ensure compliance with disease-specific care paths for specialty care or chronic disease.
• Coach patient and family on self-management support.
• Educate about managing a specialty or surgical condition (inclusive of preoperative, perioperative, postoperative and recovery) inclusive of prevention and health maintenance tasks.
• Educate and connect to other care providers and community resources to enhance care.
• Assist and support in the care coordination led by the ED provider.
• Ensure the chart contains the necessary information for the patient and is updated as needed (med lists, PCP, recent care in other hospitals, preferred pharmacies, etc.).
• Assist in real-time communication with the patient and their family when ED visits or clinical evaluations are required.
• Collaborate with local West Palm Beach Emergency Departments when patients are present for acute care, serving as the primary liaison between emergency providers and patients to ensure seamless communication and continuity of care.
• Follow-up calls on the status of a patient after being discharged from a health facility.
• Communicate with pharmacies (as needed) for prescriptions.
• Ensure diagnostic results are shared with the necessary clinical team members of the patient.
• Secure necessary follow-up appointments.
• Be available for on call at all times - relief coverage provided.

Minimum qualifications for the ideal future caregiver include:

• Graduate from an accredited school of Professional Nursing (Diploma, ADN, BSN program)
• Current state licensure as a Registered Nurse (RN)
• Basic Life Support (BLS) certification through the American Heart Association (AHA) or the American Red Cross
• Three to five years of nursing experience

Preferred qualifications for the ideal future caregiver include:

• Bachelor's of Science in Nursing (BSN)
• Specialty certification
• Outpatient/Hospital experience
• Emergency Department experience
• ACLS certification through the American Heart Association (AHA) or the American Red Cross
• Care coordination experience

Physical Requirements:

• Requires full range of motion, manual and finger dexterity and eye-hand coordination.
• Requires corrected hearing and vision to normal range.
• May requires some exposure to communicable diseases or bodily fluids.
• Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required for procedures.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration:

Please review the Equal Employment Opportunity poster.

Cleveland Clinic is pleased to be an equal employment opportunity employer.