||Nurse Navigator - Surgery
Under general administrative direction, coordinates referrals from health care facilities and individual providers; provides a significant level of patient education related to illness and planned management and treatment. The Navigator will act as the community
liaison for support programming to ensure that the patients are aware of different services offered. The Nurse Navigator will be the point of contact for the Lung Cancer Screening Program with MFA and GWUH.
Essential Duties and Responsibilities include the following. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.
• Liaison for Cardiothoracic Surgery patients in need of multiple service and support.
• Contact patient within two days of inpatient discharge for care coordination such as obtaining required specialty and PCP appointments w/in required timeline, social worker, home care set-up, medication reconciliation and ensures all summary of care documentation
is available in the chart at pending visits.
• Contact patient within set time frame for follow up after ED discharge for clinically appropriate appointment.
• Provide appropriate clinical support, counseling, and education. Alerts provider to urgent situations that cannot wait until scheduled follow up.
• Work with multi-disciplinary team to develop a plan of care focusing on reducing readmissions and addresses chronic disease conditions and social/environmental concerns that may lead to repeat hospital stays/visits.
• Work with all members of the surgical and oncological team to seamlessly coordinate the care delivered and necessary support for patient and their family.
• Clinic prep notes for new patient and returning patient which includes scanning notes/imaging, contacting referring physicians or imaging group, and contacting patients on any issues on items needed for visit.
• Pull records needed for patient from Cerner and EPIC and scan in Allscripts.
• Handout and review OR prep packet with patient.
• Order lab work, schedule testing and biopsy that are ordered.
• Assist providers in addressing insufficiencies in care provision by coordinating follow up, orders, and referrals.
Lung Cancer Screening Program
• Point person for the Lung Cancer Screening Program for the MFA and GWUH.
• Keep up-to-date records/data for the program.
• Perform all of the screening and the 1-855-GWLUNGS number calls that come directly to them.
• During screening performing smoking cessation counseling and offering cessation resources, as well as thoroughly discuss the risks/benefits of having a CT scan performed.
• Write all of the CT scan orders and interact with the referring physicians to ensure results are sent to the correct person, in addition to the thoracic surgery department.
• Reach out via email to radiology to ensure they are aware a screening candidate order is coming through the system.
• Keep track of every call whether or not the patient is a candidate for the program and interact regularly with marketing with these results.
• After patients have their scan, reach out to their physician to discuss results and recommendations. Every scan is also reviewed by a thoracic surgeon and follow up with the patient to set up whatever else is needed (ie- scan the following year or additional
testing/ consultation if necessary).