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Rn care navigator

Tonbridge
Community Hospice & Palliative Care
Care navigator
Posted: 11 June
Offer description

As an RN Care Navigator, you play a critical role in facilitating timely access to care across hospice, palliative, and home health services. Under the guidance of the Director of Care Navigation, you’ll collaborate with community partners and patient and families to remove barriers to admission and deliver compassionate, patient-centered care.
You are a skilled clinician, educator, and advocate — guiding patients and families through the transitions of care, admission process, educating referral sources, and coordinating care with an interdisciplinary team. This role demands both clinical expertise and strong interpersonal communication, with an understanding of Medicare Conditions of Participation, insurance guidelines, and regulatory requirements.

Key Responsibilities
• Serve as a clinical liaison, promoting Alivia Care services and philosophy to patients, families, and community partners.
• Assess patients for appropriate level of care (Hospice, Palliative, Home Health) using Medicare Local Coverage Determination criteria.
• Perform physical and psychosocial assessments, identify immediate needs, and document interventions in the electronic medical record.
• Facilitate admissions and ensure a seamless transition to the care team.
• Educate patients and families on available services, benefits, and advance care planning (Advance Directives, Health Care Proxy, etc.).
• Coordinate care and communicate effectively with physicians, case managers, and referral sources.
• Represent Alivia Care in hospitals and community settings; participate in in-services and public relations efforts.
• Provide mentorship to new RN staff and evaluate team members to ensure adherence to policies and standards.
• Support hospital discharge planning and transitions of care according to Medicare regulations.
• Advocate for early referrals and educate the medical community on appropriate service utilization.


Required Qualifications
• Current Registered Nurse (RN) license in the State of Florida
• Current CPR certification
• Valid Florida driver’s license with an acceptable driving record
• Reliable transportation and flexibility to work across multiple sites
• Successful completion of Level II AHCA background screening
• CHPN certification preferred
________________________________________
Education & Experience
• Graduate of an accredited nursing program (Associate’s or Bachelor’s degree)
• Minimum 2 years’ clinical experience in a hospital or long-term care setting
• ICU or Emergency Room experience a plus
• Hospice or Palliative experience strongly preferred
________________________________________
Knowledge & Skills
Clinical Knowledge:
• End-of-life care, hospice, and palliative philosophies
• Medicare Conditions of Participation and state regulations
• Symptom and pain management
• Advance care planning and healthcare proxy processes
Professional Skills:
• Strong clinical assessment and documentation abilities
• Excellent verbal and written communication
• Critical thinking and sound clinical judgment
• Ability to work independently and within interdisciplinary teams
• Compassionate, empathetic care delivery
• Cultural sensitivity and ability to support diverse populations
Tech Proficiency:
• EMR systems
• Microsoft Windows applications

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