Be a part of a world-class academic healthcare system at UChicago Medicine as a Population Health Nurse Navigator (RN) with our Care Transition Clinic. In this role, the Population Health Nurse Navigator will support the COVID Telehealth Center by screening eligible patients and provide education and shared-decision making support for the COVID Vaccine Program.

Based out of the Call Center, under the direction of a faculty sponsor and in collaboration with the program support team, the Population Health Nurse Navigator coordinates population health care needs for patients and potential patients in the community across the care continuum. Acts as a clinical liaison for patients and potential patients, across medical service, clinical departments, and locations. Assesses clinical, emotional, spiritual, psychosocial, financial, and other patient needs. Evaluates and manages patient care gaps and assists in the integration of care across departments to address those gaps.

Essential Job Functions:

• Acts as liaison for patients, families and their multidisciplinary clinical team to address the population health needs of our patients and the community
• Assesses clinical, emotional, spiritual, psychosocial, financial, and other patient needs
• Facilitates resolution to patient care gaps and monitors follow up/completion by both proactively reaching out to patients and addressing direct phone calls and messages from patients
• Educates/reinforces education with patients and families on population health measures, specific disease processes relevant to those measures, and the steps patients can take to mitigate, treat, and properly diagnose those disease processes based on the multidisciplinary care plan
• Participates in relevant quality workgroups to assist in the development of patient education materials, clinical pathways, and workflows to improve patient compliance with population health measures
• Triages, coordinates, and orders appropriate patient testing using established protocols and facilitates record gathering process if testing performed outside UCM
• Serves as primary point of contact for patients discharged from the hospital to address questions and patient care needs to prevent readmission or an emergency room visit
• Directs patients and families to available community resources and support services.
• Assists patients to overcome barriers to care, i.e. transportation, financial counseling, etc.
• May be responsible for direct patient care

Required Qualifications:

• Must have experience working in a community health setting
• A Bachelor's degree in Nursing
• Must be an actively licensed Registered Nurse in the state of Illinois
• Must have a minimum of two years' experience working as an RN

Position Details:

• Job Type/FTE: Full Time (1.0 FTE)
• Shift: Days – 8 hour shift (7:30am-4pm)
• Unit/Department: Care Transition Clinic
• CBA Code: Non-Union

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