Geriatric Care Transitions Navigator

Community-Home-Physicians; Huntley (IL); On-site; USD 45,000 - 62,000; Full time

Benefits offered by this job

401(k) match

Health, dental, and vision insurance

HSA

Life insurance

PTO

Job summary

Community Physicians is seeking a Patient Care Navigator to bridge care transitions for medically complex older adults in skilled nursing and post-acute settings. You will support families, manage EMR data, and coordinate with an interdisciplinary team to ensure seamless care and follow-up.

The role emphasizes compassionate patient advocacy, collaboration with facility staff, and accurate documentation across care transitions. Excellent communication and empathy are essential.

Qualifications

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

Responsibilities

• Transition & Family Support: Collaborate with patients, families, and multidisciplinary medical professional team; support transitions and follow-up scheduling.
• Medical Assistant & Administrative Tasks: Chart creation, data entry of demographics, medications, diagnoses; assist with transition clinic services and documentation.
• Assessments & Program Enrollment: Conduct social risk assessments; identify high-risk patients for transition services and enrollment.
• Interdisciplinary Collaboration: Be a reliable contact and advocate; participate in IDT meetings and communicate with practitioners and nurses.
• Outreach & Quality Metrics: Assist in collecting quality metrics and program improvement data.

Skills

Empathy & patient advocacy

Communication

Team collaboration

Problem solving

Education

High school diploma or equivalent

Medical Assistant program graduate

Certified Medical Assistant (CMA) preferred

Tools

EMR/EHR systems

Job description

Community Physicians is seeking a Patient Care Navigator to bridge care transitions for medically complex older adults in skilled nursing and post-acute settings. You will support families, manage EMR data, and coordinate with an interdisciplinary team to ensure seamless care and follow-up.

The role emphasizes compassionate patient advocacy, collaboration with facility staff, and accurate documentation across care transitions. Excellent communication and empathy are essential.