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Transitional Nurse Navigator - CHF/COPD
Job DescriptionJOB SUMMARY: Under the direction of the Director, Comprehensive CARE Center, the Transition Nurse Navigator is accountable for the high-risk patient population of Univ. of Md. Upper Chesapeake Health. As such, s/he takes responsibility for ensuring the continuity and coordination of patient care delivery by assessing patient needs; developing a Transitional Plan that addresses those needs; identifying and leveraging appropriate resources to implement the plan; and regularly evaluate patient progress according to the plan. Finally, the TNN communicates patient care updates and other relevant information to all stakeholders in a timely and reliable manner. 1. Identifies


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