Patient Navigator jobs in Colorado

POSITION PURPOSE:                                                                                                             

The Patient Navigator engages patients in preventative care activities and supports patients at risk of or with chronic conditions better manage their health. The patient population often includes high-risk, medically or socially complex patients who require assistance navigating barriers to ensure timely prevention, diagnosis, and treatment services, and ongoing support. The Patient Navigator works one-on-one with patients, family members, the medical care team, and other specialists as applicable to provide full-service, wrap-around care connecting patients to appropriate and necessary resources. As a member of the Population Health Management department, the Patient Navigator helps fulfill Memorial Regional Health’s (MRH) mission of improving the quality of life for the communities we serve, with patient-centered care and service excellence.

 ESSENTIAL FUNCTIONS AND BASIC DUTIES:                                                                                                             

Supervisory-Specific Performance Expectations, Duties, and Responsibilities:

• N/A

Position-Specific Performance Expectations, Duties, and Responsibilities:

• Participate in the care management of patient populations with one or more chronic conditions, who are at high risk of functional decline, symptom exacerbation, decompensation, or death. (Primary patient population: Medicare patients)
• Develop, implement, monitor, and evaluate care plans that support disease control and health management goals, including physical, mental, cognitive, psychosocial, functional and environmental factors.
• Assist patients in setting goals for healthcare self-management, track progress, provide encouragement, support, and corrective measures as appropriate to achieve positive long-term sustainable health outcomes.
• Support patients in following their care plan with frequent check-ins and follow-up.
• Outreach to patients after an emergency department or inpatient hospital visit; coordinate follow-up care with patient’s primary care physicians and specialists, as
• Perform medication reconciliation, monitor labs and other health indicators, track patient outcomes
• Interest in and ability to provide appropriate and applicable patient education (diseases, treatments, management, medications), within scope of practice and in collaboration with primary care physicians. and specialists.
• Involve patients and family members in decision-making to achieve maximum
• Track and monitor referrals; assist in scheduling appointments; follow-up on appointments and track

results; provide patient education; connect patients with resources (MRH-based, community, other providers, etc.); address care plan non-compliance and missed appointments; facilitate medication reconciliation.

• Work closely with MRH’s Wellness Nurse for collaboration and coordination of Medicare Annual Wellness Visits (MAWV), and enrollment in Chronic Care Management (CCM) as appropriate and applicable.

• Serve as the Team Lead for the Women’s Wellness Connection (WWC) and WISEWOMAN (WIWO) grant-funded programs, which support low-income uninsured and underinsured women gain access preventative care services. (Primary patient population: Medicaid patients and uninsured women)
• Apply a data driven approach to identify patients eligible for programs and services, and collaborate with patients and the primary care physicians to enroll patients and provide ongoing
• Provide basic breast and cervical health education to patients participating in the WWC
• Assist patients in setting health goals, creating plans to achieve health goals, provide support and accountability for patients, monitor goal progress for patients participating in the WIWO

• Participate in social needs screening (transportation, housing, income/ability to pay, personal safety, social isolation), and follow-up with patients to connect them to the appropriate
• Conduct and document after-visit summaries (in-person; via phone or email; etc.) to ensure follow-up care is occurring and patient needs are being
• Ensure patient interactions are properly charted in the patient electronic health record (correct coding to ensure accurate payment/reimbursement to )
• Serve as a liaison between Clinic, Hospital, and Emergency Department, EMS personnel, Imaging, Lab, Dietary, Pharmacy, Specialty Providers, Patient Billing Advocates, third-party payers, community resources, and other agencies as needed in support of patient navigation /chronic care management activities.
• Identify and maintain a network of community resources and ancillary services (MRH-based and external); participate in patient education and refer patients to appropriate
• Be able to identify patients at risk for abuse, depression, falls, or other conditions; follow the proper procedures for
• Some off-site visits to patient/client homes or in the
• Participate in the development of standardized processes and procedures that create and support efficient and effective continuity of care practices for patients served by the care coordination
• Perform other duties as assigned. Occasional weekend work to support special

Organization-Specific Performance Expectations, Duties, and Responsibilities:

• Demonstrates 100% commitment to performance in accordance with the CHOICE values of MRH and representing the organization in a positive and professional
• Establishes and maintains effective verbal and written communication and good working relationships with all patients, staff, and
• Adheres to MRH attire/dress code per policies and
• Utilizes initiative; strives to maintain a steady level of productivity; self-motivated; and manages activity and
• Completes annual education, training, in-service, and licensure/certification requirements; and attends departmental and organizational staff meetings or reads meeting
• Maintains patient confidentiality at all
• Reports to work on time as scheduled; completes work within designated
• Actively participates in departmental and organizational performance improvement and continuous quality improvement
• Strives to uphold regulatory requirements to ensure continual compliance with departmental, hospital, state, and federal regulations and
• Follows policies and procedures for infection control, safety, and risk management to ensure a safe environment for patients, the public, and
• Demonstrated success working in an integrated environment and working within a cross-functional team.

 QUALIFICATIONS:                                                                                                             

Minimum Requirements:

• Must be at least 16 years of age (21 for driving positions with a valid driver’s license).
• Must be able to legally work in the United
• Must be able to pass a background
• Must be able to pass a drug screen and breath alcohol test (if applicable).
• Must complete employee health

Required Education/Licensure/Certification:

• Unencumbered Registered Nurse (RN) licensure OR Licensed Practical Nurse (LPN) licensure in the State of Colorado
• Patient Navigation Certificate of Completion through the Patient Navigator Training Collaborative or equivalent within six months of hire
• Current BLS certification (or must be obtained within 90 days).

Experience:

• Minimum two years’ primary care, home health, or similar experience
• Minimum two years’ experience working with geriatric population preferred
• Experience with medical insurance, billing, and coding preferred
• Fluent / conversational in Spanish preferred

Skills/Abilities:

• Apply National Patient Safety goals to care and
• Work within a Healthcare Electronic Medical Record to chart and review patient data, and run reports. Communicate effectively, both in writing and
• Establish and maintain effective working relationships with employees at all levels throughout the institution.
• Interpret, adapt, and apply guidelines and
• Identify and resolve problems in a proactive, collaborative
• Commitment and leadership in regard to advancing diversity and
• Initiative and self-motivation; strive to maintain steady level of productivity and good time
• Strong analytical and critical thinking skills; attention to detail and
• Outstanding customer service
• Experience using MS Word, Excel, and Outlook.

Position Classification:  Non-Exempt 

Compensation Range:  $56,222 to $84,344

Benefits:  Medical, Dental, Life, Retirement, Paid Time Off