Manager, Patient Navigation

chenmed; United States; On-site; USD 90,000 - 130,000; Full time

Job summary

ChenMed is seeking a Manager, Patient Navigation to lead the day-to-day operations of our centralized, high-compliance call center. You will supervise Tier 1 navigators and Tier 2 RN/Licensed Social Worker staff, ensuring all interactions are triaged, worked, and documented to CMS delegation standards.

You will partner with the Medical Director for Tier 3 sign-offs and drive performance reporting across volume, conversion, staffing, and compliance metrics to senior leadership.

Qualifications

• Experience managing a healthcare call center or patient-facing operations.
• Knowledge of CMS Medicare Advantage compliance concepts.
• Ability to train and audit staff against CMS requirements.

Responsibilities

• Manages day-to-day operations of the Patient Navigation function, including staffing, scheduling, and workload distribution across Tier 1 and Tier 2 staff.
• Oversees intake and triage across in-scope workstreams, ensuring tickets are routed, worked, and documented to a closed-loop standard.
• Conducts call monitoring and documentation audits to ensure CMS delegation-oversight compliance.
• Implements maker/checker controls for cases with panel impact or clinical determination.
• Coordinates Tier 3 clinical sign-off with the Medical Director and manages review cadence.
• Tracks and reports team performance against volume, conversion, staffing, and compliance metrics to leadership.
• Escalates systemic operational issues with data-driven recommendations.
• Coaches and develops staff; leads training on process, script, and compliance updates.
• Collaborates with other departments on hand-offs for tickets outside Phase 1 scope.

Skills

Call center management

Healthcare operations

CMS Medicare compliance

Team leadership

Staff coaching

Data-driven decisions

Job description

We're unique. You should be, too.

We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We're different than most primary care providers. We're rapidly expanding and we need great people to join our team.

The Manager, Patient Navigation leads the day-to-day operations of the Patient Navigation function, a centralized, high-compliance call center model responsible for three Phase 1 workstreams: Non-CPL (Coordinated Provider List)/Out-of-Network Requests, Care Plan Non-Adherence, and Voluntary PCP Switches. This role manages a team of Tier 1 Patient Navigators and Tier 2 RN/Licensed Social Worker staff, owns quality and compliance oversight across 100% recorded interactions, and partners closely with a borrowed Medical Director who provides Tier 3 clinical sign-off on a limited, shared-capacity basis.

The Manager, Patient Navigation is accountable for ensuring every ticket - regardless of originating channel (Careline & Field-Initiated Tickets, Patient-Initiated Appeals for Clinical Review, or Non-CPL/Out-of-House Requests) - is triaged, worked, and closed-loop documented in a manner that satisfies CMS delegation-oversight standards and the terms of ChenMed's full-risk delegation agreements with its Medicare Advantage payers.

This role also owns performance reporting for the function - tracking volume, conversion, staffing utilization, and compliance metrics - and works cross-functionally with Community Nursing, APA (Acute & Post-Acute), Chen-K, Behavioral Health, and Enrollment/Eligibility Operations on hand-offs for cases outside Patient Navigation's Phase 1 scope.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES

• Manages day-to-day operations of the Patient Navigation function, including staffing, scheduling, and workload distribution across Tier 1 Patient Navigators and Tier 2 RN/Licensed Social Worker staff.
• Oversees intake and triage across all three in-scope workstreams (Non-CPL/Out-of-Network Requests, Care Plan Non-Adherence, and Voluntary PCP Switches), ensuring tickets from every originating channel are routed, worked, and documented to a closed-loop standard - with the patient, the referring care team, and the compliance record all reflecting the resolution.
• Conducts call monitoring and documentation audits across 100% recorded interactions to ensure ongoing compliance with CMS delegation-oversight standards (42 CFR 422.504), non-discrimination requirements (42 CFR 422.110), and the specific terms of ChenMed's full-risk Medicare Advantage delegation agreements.
• Implements and maintains a maker/checker control on any case with panel impact or a clinical determination, ensuring the staff member recommending an action is never the sole approver of that action.
• Partners with the Medical Director - a borrowed, partial-FTE resource - to coordinate Tier 3 clinical sign-off efficiently, managing the cadence and volume of cases requiring that review given the Medical Director's limited, shared capacity.
• Tracks and reports team performance against volume, conversion, staffing, and compliance metrics (including FTE utilization by tier, OON and Non-Adherence conversion rates, and PCP-switch processing timeliness) to senior leadership on a regular cadence.
• Monitors outcomes for any pattern suggesting a correlation with patient risk scores or cost - particularly for cases resulting in a patient leaving the panel or being reclassified - and escalates any such pattern immediately, consistent with full-risk delegation compliance obligations.
• Coaches and develops Tier 1 and Tier 2 staff based on call reviews and documentation audits; leads training on process, script, and compliance updates.
• Collaborates with Community Nursing, APA, Chen-K, Behavioral Health, and Enrollment/Eligibility Operations on hand-offs for tickets outside Patient Navigation's Phase 1 scope (e.g., unreachable-patient cases, complex clinical needs, roster/eligibility hygiene, or disruptive-behavior reports).
• Identifies and escalates systemic operational issues - including capacity constraints, tier-mix mismatches, or gaps in feeder-system data - to leadership with data-driven recommendations.
• Maintains and evolves the standard operating procedures, escalation criteria, and QA scoring rubric for the function as workstreams, volumes, or compliance requirements change.
• Performs other duties as assigned and modified at manager's discretion.

KNOWLEDGE, SKILLS AND ABILITIES

• Demonstrated ability to manage a call center or patient-facing operations team, ideally within a healthcare, health plan, or managed care setting.
• Strong working knowledge of CMS Medicare Advantage compliance concepts relevant to the function - including non-discrimination requirements, delegation oversight, grievance and appeals boundaries, and member-choice protections - sufficient to train and audit staff against them.