Geriatric Care Transition Navigator

Community Physicians; McHenry (IL); On-site; USD 29,000 - 41,000; Full time

Benefits offered by this job

401(k) with match

Health, dental, and vision insurance

Health Savings Account (HSA)

Life insurance

PTO

Travel reimbursement

Job summary

Community Physicians is seeking a Patient Care Navigator to bridge our medical teams, patients and families, ensuring smooth transitions of care across settings. You will collaborate with facility staff, manage data in the EMR, assess social needs, and connect patients with community resources, while delivering compassionate, patient-centered support.

The role involves travel between area facilities and offers full-time hours, competitive benefits, and a mission-driven, interdisciplinary team

Qualifications

• High school diploma or equivalent (Required).
• Graduate of an accredited Medical Assistant program is required.
• Certified Medical Assistant (CMA) is highly preferred.
• Minimum of 1 to 3 years of proven experience with EMR/EHR systems and taking vital signs.
• 5–7 years of experience in Skilled Nursing Facilities.
• Strong knowledge of medical terminology.

Responsibilities

• Collaborate with patients, families, and multidisciplinary medical professional team.
• Support patients and family members with transitions to the next level of care, including setting up follow-up appointments.
• Perform chart creation and data entry of patient demographics, medications, and diagnoses within the EMR system.
• Assist with transition clinic services, patient intake, phone calls, and documentation.
• Identify high-risk, complex patients who would benefit from transition services, chronic disease management, or remote monitoring, and assist them with enrollment.
• Attend IDT (Interdisciplinary Team) plan of care meetings at facilities and communicate daily with practitioners and Nurse Case Managers.
• Assist in the collection of key quality metrics and program performance improvement data.

Skills

Bedside manner

Communication skills

Compassion

Travel readiness

Education

High school diploma

Medical Assistant program graduate

Certified Medical Assistant (CMA)

Tools

EMR/EHR systems

Job description

Community Physicians is seeking a Patient Care Navigator to bridge our medical teams, patients and families, ensuring smooth transitions of care across settings. You will collaborate with facility staff, manage data in the EMR, assess social needs, and connect patients with community resources, while delivering compassionate, patient-centered support.

The role involves travel between area facilities and offers full-time hours, competitive benefits, and a mission-driven, interdisciplinary team