Nurse Navigator

Key Responsibilities

• Care Coordination & Continuum Management
• Facilitate smooth transitions of care from hospital to outpatient follow-up, rehabilitation, home health, and specialty services.
• Serve as the central point of contact for patients navigating complex cardiac care pathways.
• Ensure timely scheduling of procedures, diagnostics, and follow-up appointments.
• Collaborate with case management and social work to address barriers to care, adherence, and access.

Patient Navigation & Education

• Provide individualized patient education regarding diagnoses, procedures, treatment plans, medications, and self-management strategies.
• Support patients and families through complex cardiac episodes (e.g., new diagnosis, structural heart interventions, advanced heart failure, arrhythmia management).
• Reinforce discharge instructions and ensure patient understanding of next steps in care.
• Serve as a consistent, trusted resource to reduce anxiety, improve engagement, and enhance satisfaction.

Inpatient–Outpatient Liaison

• Act as the communication bridge between hospital-based teams and outpatient cardiology.
• Ensure timely transmission of clinical information, care plans, and procedural outcomes.
• Cook up handoffs between proceduralists, hospitalists, cardiologists, and outpatient providers.
• Support the alignment of inpatient and outpatient workflows to reduce fragmentation, delays, and duplication of services.

Service Line Support & Growth

• Enable cardiac service line initiatives, including new program development, pathway implementation, and access optimization.
• Participate in multidisciplinary rounds, service line meetings, and program development committees.
• Aid in the development and standardization of cardiac care pathways, protocols, and patient flow models.
• Identify gaps, inefficiencies, and opportunities for improvement across the cardiac care continuum.

Quality, Outcomes & Performance Improvement

• Track and monitor patient progression across episodes of care.
• Support quality improvement initiatives related to readmissions, length of stay, patient experience, procedural throughput, and care transitions.
• Aid in data collection, audits, and outcome reviews related to cardiac services.
• Promote adherence to evidence-based practice, regulatory standards, and organizational policies.

Physician, APP & Team Collaboration

• Build and maintain strong working relationships with cardiologists, surgeons, APPs, nurses, and ancillary departments.
• Support physician practices with coordination needs, patient access issues, and care navigation.
• Participate in patient case conferences and multidisciplinary care planning.

Qualifications

• Current RN license in the state of practice.
• Bachelor of Science in Nursing (BSN) required; Master’s degree preferred.
• Minimum of 3–5 years of recent clinical experience in cardiac care (e.g., cardiology, cath lab, EP, CVICU, telemetry, heart failure, or cardiothoracic services).
• Strong clinical assessment, care coordination, and patient education skills.
• Demonstrated ability to work across departments and sites of care.
• Cardiac certification (e.g., PCCN, CCRN, CMC, CSC, CHFN) preferred.
• Experience in care management, navigation, or service line coordination preferred.
• Advanced understanding of cardiac disease processes, diagnostics, and treatments.
• Strong interpersonal and communication skills with patients, families, and clinicians.
• Ability to coordinate complex care across multiple departments and providers.
• High level of organization, prioritization, and follow-through.
• Comfort with data tracking, EMR navigation, and performance metrics.
• Ability to function independently while contributing to multidisciplinary teams.