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Rn Nurse Navigator

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Blue Ridge Hospice

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Location:
United States , Winchester

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Category:
Nursing

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Contract Type:
Not provided

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Salary:

74000.00 - 104000.00 USD / Year
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Job Description:

$10,000 Sign-On Bonus – Join Blue Ridge Care Today! Your neighbors need you. Your nursing skills can change lives. Join Blue Ridge Care and become a Future Maker—where your compassion and clinical expertise help patients confidently manage complex chronic conditions and improve their quality of life every day. Our mission is simple yet powerful: “Delivering extraordinary care to improve life’s journey.” As a mission-driven, not-for-profit healthcare system, we provide integrated services in hospice, serious illness care, PACE, community thrift shops, and grief support—serving our community with heart, hope, and respect.

Job Responsibility:

  • Identify and enroll eligible patients into the PCM program and complete comprehensive initial assessments
  • Develop individualized, disease-specific care plans aligned with clinical guidelines and patient goals
  • Conduct monthly PCM interactions with accurate CMS-compliant time tracking and documentation
  • Monitor symptoms, treatment adherence, labs, and clinical changes—intervening early to prevent deterioration
  • Provide medication education, lifestyle coaching, and motivational support to improve self-management
  • Coordinate referrals, diagnostic testing, follow-up visits, and interdisciplinary communication
  • Address barriers to care including transportation, social determinants of health, and financial concerns
  • Track outcomes, engagement, and quality metrics to continuously improve chronic condition management
  • Participate in periodic call rotation and collaborate in quality improvement initiatives

Requirements:

  • Current Registered Nurse (RN) license
  • Minimum 2–3 years of clinical nursing experience (chronic disease management preferred—cardiology, pulmonology, endocrinology, rheumatology, or similar specialties)
  • Strong knowledge of chronic condition management and patient coaching strategies
  • Experience with care coordination and EMR documentation
  • Bachelor of Science in Nursing (BSN) preferred
  • Prior experience in Principal Care Management (PCM), Chronic Care Management (CCM), Case Management, or Population Health preferred
  • Certification in care coordination or chronic disease management (e.g., RN-BC in Care Coordination & Transition Management) preferred
  • Strong clinical judgment, organizational skills, and the ability to build meaningful relationships with patients and providers
  • A proactive, compassionate spirit ready to serve your community and improve life’s journey

Nice to have:

  • Bachelor of Science in Nursing (BSN) preferred
  • Prior experience in Principal Care Management (PCM), Chronic Care Management (CCM), Case Management, or Population Health preferred
  • Certification in care coordination or chronic disease management (e.g., RN-BC in Care Coordination & Transition Management) preferred
What we offer:
  • $10,000 Sign-On Bonus
  • Competitive Pay + performance rewards
  • Shift Differentials for evening and weekend shifts
  • PTO and Paid Volunteer Time
  • Comprehensive Health Benefits
  • Tuition Reimbursement & Scholarships
  • Peer Support & Mentorship
  • 30% Thrift Shop Discount
  • Growth Opportunities through the Blue Ridge Care 2030 Strategic Plan

Additional Information:

Job Posted:
March 01, 2026

Employment Type:
Fulltime
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