CARE NAVIGATOR-PPN

Premier Physician Network Quality

FT / 80 hours per pay period

Position Summary

The patient care navigator serves as a vital link between patients, families, and the healthcare team. This role focuses on guiding patients through the healthcare system, eliminating barriers to care, and ensuring seamless transitions across various medical settings. Utilizing clinical knowledge and strong communication skills, the Patient Care Navigator helps patients understand their diagnoses, treatment plans, and available resources to optimize health outcomes and reduce avoidable hospital admissions and readmissions.

The care navigator role coordinates care among patients to promote quality and population health outcomes. Responsibilities include but are not limited to outreach to Premier Physician Network patients supporting general health maintenance which include scheduling appointments, office visits and completion of quality interventions to close health care gaps. This role may work with all payers with an emphasis on medicare advantage patients as directed. This role will also communicate with providers and the health care team to coordinate care and achievement of quality goals. Review of population health data and collaboration with multiple primary care practices and groups are required along with travel within an assigned geographic area. Collaborative work with multiple interdisciplinary teams both within the Premier Health system and community are a priority. Additional responsibilities are that this role with be the lead on any appropriate clinical projects assigned by the Director of Clinical and Quality Services, Quality Manager, Supervisor or designee.

Essential Duties and Responsibilities

• Care Coordination: Coordinates appointments, diagnostic tests, and facilitates specialist referrals to ensure timely access to care; collaborates with the multidisciplinary team to implement individualized care plans. Work with high-risk complex patients that require multiple outreach and communication. Collaboration with RN Care Managers, providers and practice teams to coordinate patient education, engagement and testing.

• Patient Advocacy & Education: Acts as the primary point of contact for assigned patients; explains complex medical information, treatment regimens, and medication instructions in accessible language.

• Transition Management: Tracks patients transitioning between inpatient facilities, outpatient clinics, and home care; conducts post-discharge follow-up calls from emergency dept or as assigned to review medication reconciliation and schedule follow-up care.

• Documentation & Reporting: Maintains accurate, timely documentation of all patient interactions, barriers identified, and interventions performed within the Electronic Health Record (EHR) system. Maintain accurate and timely documentation in a confidential and compliant method utilizing the electronic medical record. Maintain strict confidentiality and follow HIPAA guidelines.

• Quality Gap Closure: Outreach to Premier Physician Network patients to complete quality gap closure and health maintenance including specific testing to complete goals. Completion of designated tests and procedures on patients at specified practice or region including but not limited to diabetic eye exams, blood draws congestive heart failure testing, blood pressure and point of care sample collection. Review of multiple payer reporting to identify gaps in care and or epic clinical registries.

• Clinical Support: Reviews and prioritizes incoming or past clinical data, review patient phone calls within the scope of practice, and escalates complex clinical issues or symptom changes to a provider or appropriate health care team member.

Required Knowledge, Skills, and Abilities

• Clinical Competence: Solid understanding of chronic disease management, preventive health maintenance, and medical terminology.

• Communication: Exceptional interpersonal and verbal communication skills; ability to build trust with diverse patient populations and collaborate effectively with medical staff and clinical or administrative teams.

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• Problem-Solving: Strong critical thinking skills to identify systemic or personal barriers to care and develop creative solutions. Must be self-directed with the ability to work independently.

• Organization: Proven ability to manage a diverse caseload, prioritize tasks, and maintain high attention to detail in a fast-paced environment.

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• Technology Proficiency: Experience navigating Electronic Health Records (EHR) and basic office software (e.g., Microsoft Office suite). Experience in a physician practice setting is preferred. Demonstrate accurate and timely data and computer skills including excel preferred. EPIC knowledge and previous use in the ambulatory setting

Qualifications

Education

Minimum Level of Education Required: High School completion / GED

Graduate from an accredited Medical Assistant program with appropriate certification

Licensure for Practical Nursing (LPN) in the State of Ohio preferred

Additional requirements:

• Type of degree: associate degree in healthcare

• Area of study or major: community health and wellness

• Preferred educational qualifications: Certified Medical Assistant, Licensed Practical Nurse

• Position specific testing requirement: N/A

Licensure/Certification/Registration

• Licensure as a Practical Nurse preferred

• Certification as a Medical Assistant

Experience

Minimum Level of Experience Required: 3 - 5 years of job related experience

Prior job title or occupational experience: Healthcare facility experience, ambulatory medical group experience, nursing home of home health agency or relevant healthcare experience

Prior specific functional responsibilities: Strong communication and analytical skills

Preferred experience: LPN or MA in an outpatient healthcare or office setting

Other experience requirements: Work with chronic disease population, population health