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GUIDE NAVIGATOR JOB POSTING

The Guiding an Improved Dementia Experience (GUIDE) Model is an initiative by the Centers for Medicare & Medicaid Services (CMS) aimed at enhancing care for individuals with dementia and their caregivers. A central role within this model is the Care Navigator, who serves as a pivotal point of contact for both patients and their caregivers.

Based out of the Geriatrics Assessment Center, in Morristown NJ, the Dementia Care Navigator will be a member of the dementia care interdisciplinary team providing comprehensive care coordination services and advance care planning in order to maintain a long-term care partnership for patients living with dementia and their care partner(s).

Key Responsibilities:

+ Conduct thorough office and home-based assessments to identify the unique health needs of individuals living with dementia.

+ Maintain regular contact with beneficiaries and their caregivers, using various modalities (in-person, phone, video calls), adjusting the frequency of contact based on the patient's complexity and needs.

+ Collaborate with an interdisciplinary healthcare team to ensure seamless delivery of comprehensive, person-centered care.

+ Provide caregivers with education and support, including direct communication and guidance.

+ Assist patients and caregivers in accessing community-based services such as meals, transportation, and respite care, including respite care services provided within GUIDE program parameters.

+ Maintains quality measurement data, collection of data to analyze, create reports for internal and federal program reporting, coordinates data collection for internal quality initiatives and identifies program benchmarks and desired quality outcomes.

+ Participate in performance improvement projects and/or quality initiatives as indicated.

Required

+ Masters Degree in Social Work (MSW) with active NJ licensure as a Licensed Social Worker (LSW)

+ A minimum of 2 years of experience in social work, care coordination, or case management within a healthcare or community-based setting.

+ Demonstrated experience working with individuals living with dementia and their caregivers

+ Demonstrated initiative, problem solving and analytical skills are essential, as well as excellent oral and written communication skills

+ Valid driver’s license and reliable vehicle is required – up to 50% of time will be spent doing home-based visits with GUIDE participants in Northern New Jersey.

Preferred

+ Relevant certifications, such as Certified Dementia Practitioner (CDP), is desirable

+ Basic understanding of medical issues commonly faced by persons with dementia and their caregivers, such as delirium, falls, infections, medication side effects, etc.

+ Experience with EPIC is beneficial

Atlantic Medical Group is a physician-led and physician-governed organization that delivers the highest quality health care, at the right place, the right price, and the right time. We are a multispecialty physician group with more than 1,000 doctors, nurse practitioners and physician assistants at over 300 locations throughout northern and central New Jersey and northeast Pennsylvania. Our mission is to deliver exceptional care recognizing the unique needs of all those we serve. Our vision is to achieve the best outcomes with our patients at the center of the physician-led team, driven by service, innovation and continuous learning.

Our integrated network offers seamless access to Atlantic Health System’s entire health care continuum and our nationally and regionally ranked hospitals. In collaboration with Atlantic Health System, several of our practices offer urgent care and walk-in services.

In addition to primary care physicians, the team includes specialists that care for patients in all aspects of their health from pediatrics to geriatrics and everything in between. We make health decisions easier for patients with enhanced access to referrals.

Atlantic Health System offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members. Offerings vary based on role level (Team Member, Director, Executive). Below is a general summary, with role-specific enhancements highlighted:

Team Member Benefits

+ Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members)

+ Life & AD&D Insurance.

+ Short-Term and Long-Term Disability (with options to supplement)

+ 403(b) Retirement Plan: Employer match, additional non-elective contribution

+ PTO & Paid Sick Leave

+ Tuition Assistance, Advancement & Academic Advising

+ Parental, Adoption, Surrogacy Leave

+ Backup and On-Site Childcare

+ Well-Being Rewards

+ Employee Assistance Program (EAP)

+ Fertility Benefits, Healthy Pregnancy Program

+ Flexible Spending & Commuter Accounts

+ Pet, Home & Auto, Identity Theft and Legal Insurance

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Note: In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits. Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer.

EEO STATEMENT

Atlantic Health System, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.