Patient Care & Access Navigator

Marshall Health; Huntington (WV); On-site; USD 42,000 - 60,000; Full time

Job summary

Marshall Health is seeking a professional to support patient engagement, care coordination, and population health initiatives in Huntington, West Virginia. The role emphasizes building relationships, guiding patients through their care journey, and aiding care teams in achieving value-based outcomes.

The position involves coordinating referrals, supporting digital health tools, and facilitating preventive services.

Responsibilities

• Establish and maintain positive, trusting relationships with assigned patients.
• Serve as a consistent point of contact throughout the patient’s healthcare journey.
• Conduct proactive outreach through telephone, text messaging, patient portal, and other approved communication methods.
• Educate patients regarding available healthcare services, resources, and preventive care opportunities.
• Encourage patient participation and self-management.
• Coordinate appointments across primary care, specialty care, diagnostics, and ancillary services.
• Facilitate timely referrals and ensure closed-loop communication between providers.
• Assist patients with follow-up after emergency department visits and hospital discharge.
• Coordinate preventive screenings and recommended follow-up care.
• Collaborate with providers and care teams to ensure continuity of care.
• Work assigned patient registries to identify and close gaps in care related to Medicare Stars measures, HEDIS quality measures, MSSP, value-based payment programs, and internal quality initiatives.
• Examples include annual wellness visits, colorectal cancer screening, breast cancer screening, cervical cancer screening, diabetic retinal examinations, kidney health evaluation, blood pressure control, diabetes monitoring, childhood preventive services, and adult immunizations.
• Assist patients with patient portal enrollment and utilization, telehealth appointment preparation, remote patient monitoring onboarding, completion of electronic forms and questionnaires, digital communication tools, and appointment reminders.
• Support Marshall Health Network’s Digital Front Door initiatives.
• Identify and assist patients experiencing barriers to care, including transportation, financial concerns, scheduling challenges, technology access, health literacy, and social needs.
• Coordinate appropriate referrals to community resources and internal support services.
• Work collaboratively with physicians, advanced practice providers, registered nurses, care managers, clinical pharmacists, behavioral health providers, dietitians, social workers, community health workers, and telehealth services.
• Escalate clinical concerns promptly to licensed healthcare professionals.
• Accurately document all patient interactions, outreach activities, barriers, referrals, and outcomes within the electronic health record and designated population health applications.
• Maintain complete and timely documentation in accordance with organizational policies.
• Participate in initiatives designed to improve patient access, quality performance, preventive care completion, chronic disease management, patient experience, utilization management, and value-based care outcomes.
• Identify workflow improvement opportunities and communicate recommendations to leadership.

Job description

Marshall Health is seeking a professional to support patient engagement, care coordination, and population health initiatives in Huntington, West Virginia. The role emphasizes building relationships, guiding patients through their care journey, and aiding care teams in achieving value-based outcomes.

The position involves coordinating referrals, supporting digital health tools, and facilitating preventive services.