Registered Nurse - Nurse Navigator - Cardiac Services

Position Title

Registered Nurse - Nurse Navigator - Cardiac Services - F/T Days

JFK University Medical Center, Edison, New Jersey

Day

Full Time with Benefits

Hackensack Meridian Health nurses care for patients and their families at every stage of life, 24 hours a day, at bedsides in 9 community hospitals, 4 academic medical centers, a behavioral health hospital, 2 children’s hospitals, 2 rehabilitation hospitals, medical offices, and care facilities across the state. Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed.

With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better – advancing our mission to transform healthcare and serve as a leader of positive change. Hackensack Meridian Health is one of the most recognized health care networks in the country for nursing excellence with 7 Magnet designations.

In joining our nursing team, you'll work with collaborative colleagues, who are pushing each other – and patient care – to keep getting better.

• Collaborative
• Courageous
• Compassionate
• Creative
• Connected

The Cardiac Nurse Navigator collaborates with cardiologists, APNs, and the entire healthcare team to oversee and support cardiac patients and their significant others. The navigator coordinates, communicates, and facilitates the care of selected patients with primary cardiac care needs. Accountable for a designated caseload, the navigator assesses, plans, and facilitates care with patients/families and healthcare professionals to meet treatment goals and arrange appropriate next steps.

The role also oversees interfacility coordination and handoff between acute and outpatient services.

• Participates in collaboration with physicians, nursing staff, and interdisciplinary team in the assessment, planning, implementation, and evaluation of care for selected patients and their families.
• All patients admitted for medical care are screened for potential eligibility to the Cardiac Transitions of Care (TOC) program; eligible patients are enrolled.
• Meets directly with patients/families to assess needs and develop an individualized needs assessment.
• Facilitates communication and coordination between team members, involving patients/families in decision‑making to minimize fragmentation of services, manage resources, and remove barriers to the discharge plan.
• Develops a TOC plan in collaboration with patients/families, patient caregivers, and the healthcare team, aligning with patient quality metrics. Confirms patients have primary care and cardiology providers upon discharge and refers appropriately.
• Works collaboratively with the multidisciplinary team and community partners for timely and appropriate transitions to the next level of care.
• Maintains current information on community resources and refers patients to enhance outcomes; consults with agencies to identify additional resources.
• Documents and communicates information to the multidisciplinary team, ensuring the electronic health record reflects patient needs, education, follow‑up care, and referrals.
• Provides patients and families with community resources and discharge care coordination options.
• Provides appropriate patient and family education regarding diagnosis, treatment, and self‑care management and documents outcomes.
• Ensures timely follow‑up appointments with appropriate providers.
• Actively participates on work groups and/or meetings, serving as a positive problem solver and identifying quality issues for review.
• Reassesses periodically, evaluating against care goals; revises plans as indicated. Medical records reflect reassessments in response to changes in needs and social determinants of health.
• Completes all other duties with attention to detail and in a timely manner.
• Monitors readmission rates for Medicare and all payers, implementing performance…