Readmission Navigator, Jackson Health System, Quality, Full Time, Days

Jackson Health System

Department: Quality & Pat Safety- Jackson Memorial Hospital

Address: Address: 1611 NW 12th Ave, Miami, Florida, 33136

Shift details: Full-Time, Days

Why Jackson:

Jackson Health System is a nationally and internationally recognized academic medical system offering world-class care to any person who walks through our doors. For more than 100 years, Jackson has evolved into one of the world's top medical providers for all levels of care, no matter if it's for a routine patient visit or for a lifesaving procedure. With more than 2,000 licensed beds, we are also proud of our role as the primary teaching hospital for the University of Miami Miller School of Medicine.

Here, the best people come together to deliver Jackson's mission for our diverse communities. Our employees are committed to providing the best CARE by demonstrating compassion, accountability, respect, and expertise in everything we do.

Job Summary:

The Readmission Navigator is a pivotal role dedicated to ensuring seamless transitions from inpatient to outpatient care by minimizing preventable readmissions. Working at the nexus of clinical care and operational transformation, this individual partners with multidisciplinary teams—including clinicians, case managers/social workers, and pharmacy—to design and implement innovative, evidence-based processes that improve patient outcomes while reducing unnecessary hospital utilization. This role's primary objective is to actively manage the transition process, leverage healthcare analytics, and integrate quality improvement strategies into day-to-day operations.

Duties and Responsibilities:

Care Coordination &  Patient Transitions:

Conduct comprehensive pre-discharge assessments and coordinate timely post-discharge follow-up. Support the patient's individualized care transition plans which may include scheduling follow-up appointments, medication reconciliation, and community resource referrals. 
Act as a central liaison between patients, families, inpatient teams, primary care providers, specialty services, post-hospitalization monitoring team, to ensure continuity of care.

Data Analytics &  Risk Stratification:

• Utilize EHR data to identify patients at high, moderate, and low risk of readmission. 
• Monitor and review key performance indicators (KPIs) such as readmission rates, follow-up compliance, and patient satisfaction metrics. 
• Review dashboards that track process improvements, outcomes, and areas for intervention.

Process Improvement &  Operational Transformation:

• Participate in identifying root cause for readmission events, identifying system and process gaps. 
• Collaborate with the Transformation/Quality Officer to design and implement quality improvement initiatives using PDSA, Lean, Six Sigma, or other continuous improvement methodologies. 
• Participate in standardizing protocols for transitional care across clinical units.

Education &  Coaching:

• Develop and deliver educational sessions for clinical teams on best practices in discharge planning and transitional care. 
• Serve as a mentor and coach for frontline staff in effective communication and care coordination strategies. 
• Participate in change management initiatives to ensure that new protocols are embedded and sustained across the organization.

Stakeholder Engagement &  Reporting:

• Prepare comprehensive reports on readmission reduction initiatives for leadership review. 
• Communicate findings and recommendations to executive teams to inform strategic decision-making. 
• Gather real-time feedback from patients and providers to drive continuous improvements.
• Perform all other related job duties as assigned.

Required Qualification:

Experience

• Generally requires 3 to 5 years of progressive experience in care coordination, transitional care, or quality improvement within a clinical or hospital setting. 
• Proven exposure to operational transformation initiatives is essential.

Education

• Bachelor's degree in Nursing, Healthcare Administration, Public Health, or a related field is required. Master's degree is preferred.

Credentials

• Current professional license as applicable (e.g., Registered Nurse, if a clinical pathway is followed) or equivalent experience in care management and quality improvement.

Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.