What are the responsibilities and job description for the Clinic Patient Navigator position at RAWLINS COUNTY HEALTH CENTER?
Summary:
This position is a pivotal role responsible for the seamless coordination of patient care transitions both internally and externally. This position leverages clinical knowledge, advanced technical skills, and proactive communication to manage referrals, overcome patient barriers, and ensure the timely return of patients for follow-up, thereby guaranteeing comprehensive, coordinated, and continuous care. The goal is optimizing clinical outcomes and improving the patient experience. The Navigator acts as a central point of contact, ensuring comprehensive communication between patients, providers, payers, and facilities to minimize care gaps, reduce barriers, and promote continuity of care with a personalized touch.
Essential Functions:
- Process and Track Referrals: Receives, reviews, and processes all outgoing specialist and diagnostic referrals initiated by clinic providers. This includes verifying referral completeness, appropriateness, and compliance with insurance requirements.
- Authorization and Verification: Obtains required prior authorizations from insurance payers and verifies patient eligibility, benefits, and financial responsibility before scheduling external services.
- Timely Scheduling: Facilitates the scheduling of external appointments, ensuring urgency levels are met, and communicates appointment details, required preparation, and documentation to the patient.
- Closed-Loop Communication: Implements and maintains a rigorous system for tracking the status of all referrals from initiation to completion, ensuring specialist reports and diagnostic results are received, logged, and reviewed by the referring provider.
- Internal Service Education: Proactively educate patients during referral processing about the range of ancillary services offered within the medical practice (e.g., in-house lab draw, physical therapy, nutrition counseling, imaging) and actively schedule these services to maintain care continuity under the referring provider.
- Resource Management: Maintains an updated directory of preferred specialists, diagnostic centers, and community resources (social services, food banks, transportation aides, etc.) to ensure timely patient access to high-quality, cost-effective care.
- Barrier Identification: Screens patients for potential barriers to care adherence, such as transportation issues, language barriers, financial concerns, or low health literacy.
- Patient Education: Clearly educates patients on their specialist visits, preparation instructions (e.g., for labs, imaging), and the importance of follow-through with the care plan.
- Complex Care Support: Provides enhanced navigation support for patients with complex or chronic conditions requiring multiple simultaneous referrals or coordination across several disciplines.
- EHR Management: Accurately documents all referral activities, authorizations, and communications with patients and external offices within the Electronic Health Record (EHR) system.
- Compliance: Ensures all processes adhere strictly to HIPAA regulations, payer rules, and internal clinic policies related to protected health information and billing compliance.
- Reporting: Generates reports on referral volumes, turnaround times, and outstanding "open" referrals to identify bottlenecks and inform continuous quality improvement efforts.
- Financial Counseling Linkage: Act as the first point of contact to identify patient concerns about the cost of external services and promptly link them to the practice's financial counseling or billing department for assistance before the referral appointment takes place.
- Return-to-Clinic Scheduling: Systematically monitor the completion of specialist visits and proactively schedule the patient's follow-up appointment with their Primary Care Provider (PCP) to review the specialist's recommendations and integrate the results into the ongoing care plan.
- Post-Consultation Triage: Request specialist reports and upon receipt of the report, quickly triage the documentation to the PCP for review and alert the patient to any new orders, medication changes, or urgent follow-up actions recommended by the specialist.
- Medication Reconciliation Support: Assist the clinical team by ensuring the patient understands any new medications or dosage changes prescribed by the specialist, confirming their ability to obtain the prescriptions, and scheduling a medication review appointment with the PCP or nurse if necessary.
- Professional Conduct: Maintains a professional, customer-friendly environment that treats patients and families with respect and dignity, fostering positive public relations for the organization.
- Policy Adherence: Meets all organizational policies and procedures, including QA, Safety, Infection Control standards, and is responsible for communicating relevant clinic policies to patients and families.
- Professional Development: Participates in required in-service training and other opportunities for professional development as assigned by management.
- Coordinates Closely with Primary Care Providers (PCPs), Specialty Schedulers, Nurses, Medical Assistants, and Clinic Social Workers.
- Exceptional ability to communicate clearly, professionally, and concisely with diverse parties, including patients, clinical staff, insurance representatives, and external specialty office schedulers.
- Proactive ability to identify patient barriers to care (e.g., financial, transportation, literacy) and effectively advocate for the patient by linking them to appropriate internal and community resources.
- Ability to remain professional and calm while managing stressful or complex authorization denials, scheduling conflicts, or frustrated patients, focusing on finding efficient solutions.
- Excellent skill in rapidly assessing the clinical urgency of referrals and diagnostic orders to prioritize workload and meet timely scheduling deadlines set by clinical need and payer requirements.
- Advanced knowledge of medical terminology, common procedures, and diagnostic test preparation (e.g., fasting, medication adjustments) to effectively communicate with patients and external providers.
- Performs all other duties as may be assigned by management staff.
Competencies:
- Expert working knowledge of medical insurance processes, managed care, and prior authorization requirements for specialists, diagnostics, and procedures. Must accurately interpret complex insurance benefits and rules.
- High proficiency in using Electronic Health Record (EHR) systems for tracking, documentation, scheduling, and generating reports. Ability to efficiently use multiple external insurance and facility portals.
- Maintains meticulous records of all referral communications, authorizations, and follow-up activities to ensure a verifiable audit trail.
- Exceptional verbal and written communication, customer service, and active listening skills, vital for successful patient advocacy and coordination with diverse parties.
- Strong organizational skills and process management abilities necessary to handle a high-volume, closed-loop referral system with strict attention to detail.
Position Qualifications:
Minimum Education: Associate or Bachelor’s degree in a health-related field (e.g., Nursing, Social Work, Public Health, Health Administration) required. Clinical background (e.g., MA, LPN, or equivalent experience) preferred.
Minimum Experience: Minimum 1-2 years of experience in a healthcare setting (medical clinic/hospital), or experience in patient navigation, care coordination, utilization management, or a similar role within an outpatient clinic or hospital setting.
Certifications/Licensures: Active license as a Licensed Practical Nurse (LPN) or Registered Nurse (RN); certification in case management, certified patient navigator or community health worker preferred.
Working Environment:
Based in the clinic setting. Most of the work is performed at a computer workstation, utilizing the EHR, insurance portals, and communication systems. Must be comfortable working in a fast-paced, data-driven operational hub environment where clinical judgment meets administrative efficiency to ensure seamless patient transitions. The environment requires a strong emphasis on customer service and patient advocacy, as the Navigator is responsible for reducing patient frustration and confusion during complex care transitions.
Salary : $17 - $22