Mass General Brigham

Site: The Brigham and Women's Hospital, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Backfill replacement for employee that was promoted

Job Summary

Under the direction of the clinical director and operations director, the Patient Transition Navigator is a non-clinical role that supports patients and families as they move between different levels of care, such as hospital discharge to home, outpatient services, or skilled nursing facilities. The Navigator ensures that patients understand their care plans, receive appropriate follow-up services, and are connected to community and social support resources. This role enhances the patient experience during transitions of care. Responsible for working closely with patients, families, and healthcare providers to ensure a seamless and patient-centered care experience by assisting with navigating the complexities of the healthcare system, coordinating resources, and providing support to improve patient outcomes.

Qualifications

• A bachelor's degree in public health, clinical social work, healthcare management, or a related field is required.

Responsibilities:

Care Coordination & Navigation:

• Coordinate logistical aspects of care transitions, including transportation, follow-up appointment scheduling, and referrals to post-acute or specialty services.
• Collaborate with the interdisciplinary healthcare team—including case managers, social workers, schedulers, and clinical staff—to align and support care plans.
• Serve as a liaison between patients, healthcare providers, and external stakeholders to promote smooth communication and continuity of care.
• Track patient progress after discharge, identify barriers to follow-up care, and help resolve non-clinical challenges.
• Conduct timely post-discharge outreach calls to assess needs, confirm service access, and provide ongoing support.

Patient Support & Advocacy:

• Serve as a consistent, non-clinical point of contact for patients and families during care transitions, helping them understand what to expect after discharge or transfer.
• Assist patients in understanding and adhering to their care plans, escalating any clinical questions to licensed team members.
• Ensure patients are informed and empowered to participate in healthcare decisions actively.

Documentation & Process Improvement:

• Maintain accurate and timely documentation of patient interactions, care plans, referrals, and follow-up efforts in the electronic health record.
• Contribute to initiatives aimed at improving the patient experience, reducing care delays, and streamlining care transitions.
• Undertake other tasks as assigned.

Additional Job Details (if applicable)

Remote Type

Onsite

Work Location

45 Francis Street

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

EEO Statement:

The Brigham and Women's Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.