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Backfill replacement for employee that was promoted
Job Summary
Under the direction of the clinical director and operations director the Patient Transition Navigator is a non-clinical role that supports patients and families as they move between different levels of care such as hospital discharge to home outpatient services or skilled nursing facilities. The Navigator ensures that patients understand their care plans receive appropriate follow-up services and are connected to community and social support resources. This role enhances the patient experience during transitions of care. Responsible for working closely with patients families and healthcare providers to ensure a seamless and patient-centered care experience by assisting with navigating the complexities of the healthcare system coordinating resources and providing support to improve patient outcomes.
- A bachelors degree in public health clinical social work healthcare management or a related field is required.
Responsibilities:
Care Coordination & Navigation:
- Coordinate logistical aspects of care transitions including transportation follow-up appointment scheduling and referrals to post-acute or specialty services.
- Collaborate with the interdisciplinary healthcare teamincluding case managers social workers schedulers and clinical staffto align and support care plans.
- Serve as a liaison between patients healthcare providers and external stakeholders to promote smooth communication and continuity of care.
- Track patient progress after discharge identify barriers to follow-up care and help resolve non-clinical challenges.
- Conduct timely post-discharge outreach calls to assess needs confirm service access and provide ongoing support.
Patient Support & Advocacy:
- Serve as a consistent non-clinical point of contact for patients and families during care transitions helping them understand what to expect after discharge or transfer.
- Assist patients in understanding and adhering to their care plans escalating any clinical questions to licensed team members.
- Ensure patients are informed and empowered to participate in healthcare decisions actively.
Documentation & Process Improvement:
- Maintain accurate and timely documentation of patient interactions care plans referrals and follow-up efforts in the electronic health record.
- Contribute to initiatives aimed at improving the patient experience reducing care delays and streamlining care transitions.
- Undertake other tasks as assigned.
Additional Job Details (if applicable)
Onsite
45 Francis Street
40
Regular
Day (United States of America)
The Brigham and Womens Hospital Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.