Care Navigator

Appalachian Regional Healthcare (ARH); Whitesburg (KY); On-site; USD 45,000 - 60,000; Full time

Job summary

Appalachian Regional Healthcare (ARH) is seeking a Care Navigator to coordinate access to ARH services across the hospital, home care, pharmacy and community resources. You will work with care teams to plan discharge and ensure smooth transitions for patients, including medication access and prior authorizations.

The role emphasizes collaboration, strong communication with patients and providers, and meticulous documentation of services and outcomes across ARH facilities in Whitesburg, KY.

Qualifications

• Coordinate access to ARH services across the care continuum.
• Assist patients with medication access and prescription services.
• Communicate with patients, caregivers, physicians, pharmacies and insurers.
• Maintain accurate records and program documentation.

Responsibilities

• Work collaboratively with care providers to coordinate access to care.
• Identify service opportunities including pharmacy, home care, home health and other resources.
• Make follow-up contacts to high-volume patients for local and system services.
• Deliver prescriptions and supplies to patients or caregivers.
• Assist patients with payment requirements and complete paperwork for access programs.
• Obtain prior authorizations and coordinate with service line directors post-discharge.
• Act as liaison between providers and pharmacy staff to resolve access issues.
• Initiate follow-up communications regarding medication access status.
• Maintain records and statistics for program evaluation.

Skills

Care coordination

Effective communication

Discharge planning

Medication access

Record keeping

Customer service

Education

High School Diploma

Associate's Degree

Job description

Overview

The Care Navigator is responsible for coordinating access to ARH services across all areas of their healthcare community (includes hospital, retail pharmacy, home care, home health, indigent care, etc.).

Responsibilities

• Work collaboratively with care providers to coordinate and plan access to care for patients across the ARH continuum.
• Work with nursing and care managers to identify ARH service opportunities, including retail pharmacy, home care services, home health services, and other resources for patients being discharged.
• Make follow-up contacts to high-volume patients for local and system services.
• Provide a local resource to transition follow-up services, such as prescription refills, through system services including prescription mail-order programs.
• Promote and coordinate home care services for post-discharge durable medical equipment and home health orders.
• Deliver completed prescriptions and supplies to patients or their caregivers.
• Assist patients in processing payment requirements.
• Assist in the completion of paperwork for medication access programs.
• Contact other resources for patient information to enhance ARH services.
• Work with physicians and social services to obtain insurance prior authorizations for medications as needed.
• Coordinate with local service line directors to provide continuous and coordinated services following discharge.
• Serve as a liaison between providers and pharmacy personnel to facilitate the prior authorization process and resolve medication access and adherence issues.
• Act as a direct contact for patients requiring assistance or updates regarding prior authorizations.
• Initiate follow-up communications with patients and providers concerning the status of medication access issues.
• Perform direct entry and maintenance of patient applications for services.
• Respond to and provide additional information and/or appeals as required by pharmaceutical companies.
• Maintain records and statistics for evaluation and program analysis purposes.
• Maintain general knowledge of manufacturer indigent patient program criteria and communicate changes and developments.
• Investigate and analyze critical operational situations and provide direction for problem resolution.
• Perform other related duties as assigned.
• Travel as required.

Education

• High School Diploma required.
• Associate's Degree preferred.

Experience

• Experience requirements not specified.

Licenses & Certifications

• Licensed Practical Nurse (LPN) State Licensure preferred upon hire.

Required Skills, Knowledge & Abilities

• Ability to work collaboratively with care providers to coordinate patient access across the continuum of care.
• Ability to assist patients with medication access, financial assistance programs, and prescription services.
• Knowledge of healthcare services, discharge planning, and community resources.
• Ability to communicate effectively with patients, caregivers, physicians, pharmacies, social services, and insurance providers.
• Ability to obtain, track, and follow up on medication prior authorizations.
• Ability to maintain accurate records, statistics, and patient program documentation.
• Ability to investigate and resolve medication access and operational issues.
• Strong organizational, communication, and customer service skills.
• Ability to handle sensitive patient information confidentially.
• Ability to travel as required.