PATIENT NAVIGATOR

PATIENT NAVIGATOR

Reports To: Deputy Director of Case Management and Care Coordination

Supervises: None

Department: Operations

Job Summary

The Patient Navigator actively participates in care management and coordination activities for patients within the primary care practice. This position supports clinical teams by developing and monitoring workflows, utilizing patient registries and third-party payer portals, documenting patient information, and promoting quality outcomes through effective patient engagement and coordination.

Essential Functions

• Coordinate and schedule patients for Annual Wellness Visits (AWVs) and the closure of clinical care gaps.
• Work directly with Medicare Advantage plans and other third-party payers.
• Support Franklin Primary Health Center’s participation in value-based care and quality incentive programs.
• Utilize patient registries and payer-supplied reports to identify patients requiring outreach.
• Enter and submit patient data into applicable payer portals using information documented in the electronic health record (EHR).
• Apply HEDIS quality measures in daily operations.
• Accurately document patient interactions within the electronic health record.
• Attend required quality meetings and payer training sessions.
• Maintain organized records supporting quality performance metrics.
• Communicate effectively with patients, providers, and payer representatives.
• Provide exceptional customer service during all patient and payer interactions.
• Collaborate with primary care teams to improve patient outcomes.
• Promote patient engagement and participation in preventive healthcare activities.
• Serve as a resource to providers and care teams to support quality improvement initiatives.
• Participate in ongoing professional development related to Medicare Annual Wellness Visits and quality measures.

Skills

• Knowledge of medical practice and patient care.
• Knowledge of clinical quality assurance principles.
• Strong critical thinking and problem-solving skills.
• Ability to interpret and apply clinical guidelines and protocols.
• Ability to maintain accurate medical records.
• Excellent interpersonal and communication skills.
• Strong organizational and time-management skills.
• Proficiency with Microsoft Office and electronic health records.
• Ability to work independently and collaboratively.

Customer Satisfaction Requirements

Provide exceptional customer service to patients, visitors, guests, and staff by demonstrating professionalism, courtesy, respect, and responsiveness while maintaining patient confidentiality.

Health & Safety Requirements

• Comply with all safety regulations, personnel policies, and procedures.
• Complete annual Safety and Hazard Communication training.
• Maintain required employee health records, including TB testing and hepatitis immunization requirements.

Privacy Rule Compliance

• Comply with all HIPAA Privacy Rule policies and procedures.
• Complete annual HIPAA Privacy Rule training.
• Protect patient confidentiality and maintain appropriate security of patient information.

Qualifications

• High school diploma or equivalent required.
• Experience in healthcare coordination, quality programs, or administrative support preferred.
• Strong organizational and time-management skills.
• Excellent customer service and communication skills.
• Ability to work independently and collaboratively across departments and payer networks.
• High attention to detail and accuracy in documentation.

Knowledge, Skills & Abilities

• Demonstrates strong administrative and organizational skills.
• Assumes responsibility for continued professional growth.
• Maintains professional conduct, sound judgment, and appropriate appearance.
• Communicates effectively and works cooperatively with others.
• Maintains good health and consistent attendance.

Other Qualifications

Strong English communication skills are required. Bilingual and bicultural candidates are encouraged to apply.

Physical/Mental Demands

• Ability to express ideas clearly and exercise sound judgment.
• Ability to sit and stand for extended periods.

Protected Health Information (PHI) Access

This position has Restricted access to Protected Health Information (PHI) and must comply with all HIPAA privacy and security requirements.

Classification: Hourly

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