Clinic Chronic Care Navigator

Job Title

Responsible for assisting in coordinating team-based care, to provide health services to individuals, through effective partnership with patients, their caregivers/families, community resources and members of the Care Team.

Essential Functions

Serve as the contact point, advocate, and informational resource for patients, care team, family/caregiver(s), payers, and community resources.

Work with RN's and payers to plan and monitor patient care.

Assess patient's unmet health and social needs.

Facilitate patient access to appropriate medical and specialty providers.

Educate patient and family/caregiver(s) about relevant community resources.

Facilitate and attend meetings between care team, payers, and community resources, as needed

Assist with the identification of "high-risk" patients (the chronically ill and those with special health care needs), and add these to the patient registry (or flag in EHR)

Follow up and monitor patients via payer work lists to assist in scheduling and following patient chronic care diagnosis.

Attend all Care Coordinator training courses/webinars and meetings

Display knowledge of preventative health requirements

Maintain regular and predictable attendance

Perform other essential duties as assigned

Education/Experience/Skill Requirements

Current Certified Medical Assistant certification or licensed practical nurse

Two years' experience as a CCMA or LPN required

BLS

Previous experience in caring for chronic disease patients preferred

Two years' experience in clinical or community health setting preferred

Previous Care Coordination, Case Management or Home Health experience preferred

Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the hospital/clinic.

Western Missouri Medical Center