Care Navigator Registered Nurse (RN)

HopeHealth•Attleboro, MA

About The Position

The Care Navigator RN serves as a primary representative of HopeHealth within assigned hospitals, skilled nursing facilities, assisted living communities, physician practices, health centers, and the broader community in southeastern Massachusetts. This role is responsible for advancing organizational growth and strengthening HopeHealth’s reputation through relationship development, clinical expertise, and exceptional service. The Care Navigator RN plays a critical role in promoting hospice and palliative care services, facilitating timely and appropriate transitions to care, and ensuring a seamless experience for patients, families, and referral partners. As a subject matter expert in all HopeHealth service lines, the Care Navigator RN provides education, conducts goals-of-care conversations, and supports patients in navigating serious illness care options. The ideal candidate is compassionate, highly motivated, intellectually curious, and committed to excellence in serious illness care delivery.

Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
RN required; Bachelor of Science Degree in Nursing preferred; five plus years of nursing experience.
Hospice, palliative care or experience working with seriously ill patients preferred but not required.
RN license in MA required. Valid driver’s license with an automobile that is insured in accordance with state and/or agency requirements and is in good working order.

Responsibilities

Cultivates and maintains strong relationships with key stakeholders across assigned hospitals, nursing homes, assisted living facilities, physician offices, health centers, and community organizations to support growth in hospice and palliative care services.
Serves as a subject matter expert on all HopeHealth services, including hospice, palliative care, dementia support, caregiver support, bereavement services, and community education.
Educates patients, families, and referral partners on hospice and palliative care services, clearly communicating benefits, eligibility criteria, and care options.
Conducts goals-of-care conversations, hospice informational visits, and clinical evaluations to support appropriate care planning and timely transitions.
Collaborates closely with interdisciplinary teams and the Access Center to ensure a seamless, high-quality referral and admission experience.
Coordinates care transitions and facilitates communication among providers, patients, and families to ensure continuity and alignment of care.
On occasion, completes hospice admissions.
Documents all patient interactions, evaluations, and referral activities accurately and in a timely manner within the electronic medical record (EMR).
Utilizes CRM tools effectively to track territory activity, identify growth opportunities, and document outreach efforts, follow-ups, and outcomes.
Organizes and participates in care coordination meetings and addresses service recovery opportunities as needed.
Provides professional and community education programs on hospice and palliative care, as requested.
Actively participates in professional and community events, conferences, and networking opportunities to enhance relationships and expand organizational reach.
Demonstrates flexibility by supporting coverage needs across territories as required.
Consistently reflects HopeHealth’s mission, vision, and values while adhering to all organizational policies, including quality assurance, safety, infection control, and HIPAA compliance.
Performs additional duties as assigned.