Patient Care Navigator

Job Description

Job Description:\n\n About Company:We Are Different!\n Hendry Regional Medical Center is THRIVING! We have infused our culture with a focus on positivity for our teams. We know that a Healthy-Happy Workforce creates positive outcomes. Our banner is THRIVE!\n T-Trust\n We are committed to establishing trust at all levels, understanding that this is the foundation for all human relationships.\n H-Honest-Authentic Communication\n We understand the importance that communication plays in healthcare-but more importantly the ability to communicate-honestly and authentically is paramount for creating a healthy workforce.\n R-Respect\n It is not just a word-it is an expectation to give, and receive respect, at every level of our organization.\n I-Innovation and Inclusion\n We promote inclusion, and embrace understanding that the diversity of inclusion leads to the surprise of innovation! We have great thinkers with great ideas!!\n V-Vulnerability\n Vulnerability is a critical ingredient in creating trust. We support the effort, even if the outcome is different than expected. We understand the learner-is also a trier which means they don’t always succeed, but they always learn! We are here for each other first!\n E-Expectation/Excellence\n Our expectation is always to provide excellence-this extends first to each other, by creating a healthy-happy workforce. We provide an environment that Help Our People to THRIVE by creating JOY at Work!\n About the Role:\n The Patient Care Navigator serves as the central point of communication and coordination for patient care services, ensuring patients receive timely, efficient, and seamless access to healthcare resources. This role serves as the primary point of contact for scheduling primary care appointments and ensuring patients are connected to appropriate healthcare services in a timely manner. The Patient Care Navigator manages the end-to-end referral process, including coordinating internal and external referrals, obtaining and tracking authorizations, scheduling appointments, and ensuring referrals are completed and communicated back to the referring provider. This role is responsible for coordinating ancillary and diagnostic services and supporting continuity of care through effective communication and care coordination. The Patient Care Navigator collaborates closely with patients, providers, clinical support staff, patient coordinators, medical records, and authorization teams to support continuity of care, improve access to services, enhance patient satisfaction, quality, ensures effective communication and follow-up throughout the patient's healthcare journey.\n Minimum Qualifications:\n \n High school diploma or equivalent,\n Two (2) years of outpatient clinic experience required. \n Working knowledge of referral and prior authorization processes, payer benefit structures, and medical terminology required.\n Experience working in a healthcare setting, preferably in patient advocacy, case management, or care coordination.\n Strong interpersonal and communication skills to effectively interact with diverse patient populations and healthcare professionals.\n Basic knowledge of healthcare systems, insurance processes, and community resources.\n Ability to manage multiple tasks, maintain confidentiality, and demonstrate empathy and cultural sensitivity.\n \n Preferred Qualifications:\n \n Associate degree or higher in healthcare, social work, or related field.\n One (1) year of referral, authorization, or care coordination experience.\n Certification as a Patient Navigator or Case Manager (e.g., Certified Patient Navigator, CCM).\n Experience with electronic health records (EHR) and healthcare management software.\n Bilingual abilities to support non-English speaking patients.\n Familiarity with chronic disease management and patient education techniques.\n \n Responsibilities:\n Patient Care Navigator \n \n Gather, verify, maintain and document accurate up to date patient demographic, financial and health information into hospital information system and other applications as required.\n Serves as the first point of escalation for clinical support staff, patient coordinators, and front office staff on patient care and workflow issues.\n Monitors same-day and next-day appointment availability and escalates to the Practice Manager/ Clinical Coordinators when the site is at risk of missing the access standard.\n Transcribes, receives, and interprets provider orders for assigned patients and carefully documents all patient-related information in the EMR.\n Demonstrates an ability to respond and provide direction in changing workload and during crisis and emergent situations.\n Consistently demonstrates an awareness of patient rights and functions as the patient's advocate.\n Schedule, monitor, and verifies appointments. \n Performs basic secretarial skills. \n \n Appointment Coordination and Phone Access\n a. Coordinates appointment scheduling for the site across both internal HRMC services and external providers, ensuring the patient leaves each encounter knowing what is scheduled, where, and when.\n b. Answers, triages, and returns patient telephone inquiries within established turnaround standards. Returns patient voicemail messages the same business day whenever received before the close of business, and no later than the next business day.\n c. Monitors the site telephone queue, call abandonment, and message backlog throughout the day, redistributing staff coverage to protect telephone access during peak periods.\n d. Ensures clinical questions requiring provider input are routed the same business day and that the patient receives an acknowledgement even when a final answer is pending.\n e. Monitors the site scheduling template for accuracy, holds same-day and urgent capacity as directed, and escalates when held capacity is exhausted.\n f. Confirms upcoming appointments and performs proactive outreach on no-show and cancellation follow-up to keep utilization and continuity on track.\n g. Documents all telephone communication and appointment coordination activity in the electronic health record.\n h. Assist patients with the set up and maintenance of their patient portal. \n Internal Referral Management\n a. Coordinates referrals to Hendry Regional Medical Center services, including cardiology, orthopedics, general surgery, physical therapy, occupational therapy, podiatry, behavioral health, diagnostic imaging (X-ray, CT, MRI), mammography, DEXA, colonoscopy, and laboratory services.\n b. Verifies, prior to scheduling, that each ordered service is correctly identified under the applicable cost tier for the patient's coverage, so that the patient is quoted accurately and the service is billed correctly.\n c. Schedules the internal referral appointment before the patient leaves the visit whenever the destination service permits, and provides the patient with written date, time, location, and preparation instructions.\n d. Coordinates same-visit laboratory and X-ray services where clinically appropriate so that the patient completes diagnostics during the original encounter.\n e. Documents each referral in the electronic health record, including referring provider, destination service, date of order, date scheduled, and date completed.\n f. Monitors pending internal referrals daily and works an active worklist until each referral is either completed, rescheduled, or formally closed.\n g. Confirms that the consult note or diagnostic result is returned to the referring provider and documented in the patient record and notifies the provider when a result is outstanding beyond the expected turnaround.\n h. Reports referral volume, scheduling turnaround, and completion status to the Practice Manager on the established reporting cadence.\n External Referral Management\n a. Coordinates referrals to outside specialists, facilities, and diagnostic providers when the required service is not available within Hendry Regional Medical Center or when the patient elects to receive care elsewhere.\n b. Respects and documents patient choice of provider at all times. Patients are never required, pressured, or induced to receive services within HRMC, consistent with the Florida Patient Brokering Act and the Florida Patient Self-Referral Act.\n c. Verifies patient insurance, submits requests for prior authorization, and follows up in a timely and appropriate manner until a determination is received.\n d. Reviews incoming authorizations for errors and appropriateness and obtains corrected authorizations when necessary.\n e. Communicates with insurance companies, patients, and other relevant parties to obtain authorizations, and advises scheduling and clinic staff which patients may be scheduled.\n f. Assembles and transmits the clinical documentation required by the receiving provider and works with providers and clinical support staff on requests for missing documentation.\n g. Tracks external referrals through to completion, obtains the consult report, and ensures it is scanned into the patient record and routed to the referring provider.\n h. Documents the reason a referral was directed outside HRMC, for use in service line planning and access improvement.\n i. Escalates to the Practice Manager or Clinical Coordinator where an external referral is delayed in a way that may affect patient care.\n Prior Authorization and Ancillary Services\n a. Owns prior authorization from submission through determination for ancillary and diagnostic services, including colonoscopy, CT, MRI, and other imaging and procedural services.\n b. Submits authorization requests within one (1) business day of the provider order, and tracks each request to a documented determination rather than to submission alone.\n c. Maintains an active authorization worklist, follows up with the payer on pending determinations, and escalates any request approaching a clinically significant delay.\n d. Reviews approvals for accuracy, including procedure codes, units, facility, and validity dates, and obtains corrected authorizations where errors are identified.\n e. Schedules the ancillary service promptly once authorization is obtained, and notifies the patient of the date, location, preparation requirements, and expected cost responsibility.\n f. Communicates authorization denials to the referring provider the same business day and supports the appeal or peer-to-peer process as directed.\n g. Attaches authorizations to the patient record and documents authorization number, determination date, and expiration.\n h. Reports authorization completion rate and turnaround time to the Practice Manager on the established reporting cadence.\n Employer Program and Member Support\n a. Verifies enrollment and eligibility for patients covered under employer care delivery programs at the time of scheduling and at the time of service.\n b. Applies the correct cost tier when scheduling services for enrolled members and escalates any service whose tier assignment is unclear rather than quoting the patient.\n c. Coordinates with the Client Service Representative structure on member scheduling, intake, and issue resolution.\n d. Explains covered services and expected patient responsibility accurately and, where the answer is not certain, obtains confirmation before the patient is given a figure.\n e. Maintains strict confidentiality of member health information and does not disclose individual member clinical information to any employer, plan sponsor, or third party.\n f. Supports accurate capture of appointment, laboratory, imaging, and result timestamps in the electronic health record so that patient throughput can be reported.\n g. Participates in off-site activities that drive program awareness, engagement, and appropriate utilization, including off-site enrollment events, open enrollment sessions, benefit fairs, screening and wellness events, and staff meetings. \n h. Coordinates scheduling and follow-up arising from off-site events so that interest generated at an event converts into a booked appointment.\n i. Serves as a recognizable point of contact for contracted employees at the site and supports their human resources and benefits staff on access and scheduling questions.\n j. Provides feedback to the Practice Manager and clinical coordinators on member questions, barriers, and objections encountered during off-site activities to inform communication and access improvements.\n Patient Satisfaction and Service Recovery\n a. Accountable for patient satisfaction performance at the site and for the patient's experience of access, communication, and follow-through.\n b. Reviews post-visit patient satisfaction results with the Practice Manager, identifies recurring themes, and participates in developing and executing improvement actions.\n c. Responds to patient concerns and complaints at the point of service, performs service recovery within the scope of the position, and escalates unresolved concerns to the Practice Manager the same business day.\n d. Rounds on patients in the waiting and clinical areas to identify and resolve delays, communication gaps, and unmet needs before they become complaints. \n e. Keeps patients informed of wait times and delays proactively rather than in response to a question.\n f. Models and reinforce THRIVE service standards among clinical support staff at the site and coaches to those standards’ day to day.\n g. Documents patient concerns, resolutions, and service recovery actions in accordance with hospital policy.\n Records, Authorizations and Documentation\n a. Works closely with providers and clinical support staff to support requests from patients and outside entities in obtaining records to support the patient's care.\n b. Verifies legitimacy, accuracy, and authority of medical record requests, and ensures signed releases are scanned into the patient's medical record.\n c. Reports breaches, instances of non-compliance, patient complaints, problems, or similar instances to the supervisor in order to protect patient health information.\n d. Handles protected health information in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).\n e. Maintains confidentiality within the workplace and within the community.\n f. Communicates and completes handoff for referrals and authorizations for effective documentation of patient care.\n g. Participates in staff meetings and other meetings as instructed.\n h. Work additional hours as required.\n Compliance/Financial/Risk\n a. Supports HRMC's Mission Statement and follows the Medical Center's Compliance Program and Ethical Standards of Conduct.\n b. Supports Departmental Policies related to compliance and completes documentation in observance of regulatory Standards.\n c. Maintains a knowledge base of HIPAA and HITECH awareness and complies appropriately.\n d. Attends training and in-services concerning all aspects of assigned duties, including federal and state statutes, regulations and guidelines.\n e. Reports any incidences of