Patient Care Navigator

California Jobs; Los Angeles (CA); Hybrid; USD 50,000 - 70,000; Full time

Job summary

A leading healthcare provider in Los Angeles is seeking a Patient Care Navigator to support care coordination efforts within the Care Management Program. The ideal candidate will facilitate access to care and health resources for patients, ensuring effective communication among all stakeholders. This full-time position requires a degree and experience in case management or care coordination, emphasizing the need for strong communication skills and the ability to engage with diverse populations. The role will also include administering programs like Remote Patient Monitoring and conducting health assessments.

Qualifications

• Previous experience providing case management and/or care coordination for vulnerable populations preferred.
• Legal authorization to work in the US required.
• Bilingual in one of LA's Medi-Cal languages highly desirable.

Responsibilities

• Support care team by connecting patients to social support services.
• Conduct health assessments to develop health action plans.
• Administer the Remote Patient Monitoring program.

Skills

Critical thinking

Effective verbal and written communication

Ability to connect and engage with diverse populations

Motivational interviewing

Education

Associate's or Bachelor's degree

Job description

JOB DESCRIPTION
POSITION: Patient Care Navigator
STATUS: Non-exempt; Full time
REPORTS TO: Director of Performance Improvement
SUPERVISES: None
DEPARTMENT: Performance Improvement
UNIT: Care Management Program (not Unit yet)
OFFICIAL DUTY STATION: hybrid/clinic location TBD
SUMMARY:
The Patient Care Navigator (PCN) performs essential functions of care coordination as
part of the expanded Care Team and Care Management. The PNC is responsible for
providing short-term services based on a care plan for the referred client/patients as
related to utilization/ follow-up of external community resources and specialty referrals.
The PNC manages specified cases, coordinates health care benefits, provides education
and facilitates our patients/members access to care in a timely and cost-effective manner.
The PNC collaborates and communicates with patients/members, family/support
persons, providers, to promote wellness and member empowerment, while ensuring
access to appropriate services and maximizing member benefit. The PNC serves as an
active interdisciplinary team member, liaison with other departments and external health
and social service providers. This position helps address patients and members social
needs that may be identified during such screening workflow, ECM work, or Care
Management service provided by RNs.
The PNC, as part of the Care Management Program, shall also assist in other care
coordination programs as assigned by Director of Performance Improvement, including
administration of (1) APHCV's Remote Patient Monitoring (RPM) Program, where he/she
will monitor and track distribution of RPM equipment, provide and/or facilitate patient
education on the use and care of the RPM equipment, and provide overall implementation
coordination of the RPM program; (2) Care coordination of AWV visits for Medicare or
MediCal beneficiary including outreach and appointment scheduling and other programs
as assigned.
Patient Care Navigator (PCN) Page 2
Care Coordination provided byas PNC is an essential part of the clinic care team to
support, guide and assist patients and families through the arrays of healthcare
systems, acts as a communication liaison to understand the patients' individual needs,
preferences, and concerns, collaborates with the core care team (Provider and MA),
extended care team (Big Care Team, Clinic Operations, other units) and external
service providers, including community-based organizations to support a coordinated
care for the Patient.
The Care Management Program is currently in the Department of Performance
Improvement. However, the Program might become a Unit and transferred to another
Department in the near future.
APHCV expects all employees to respond and participate to emergency situation per
emergency policies and procedures.
APHCV requires all staff to comply with Standards of Conduct and Compliance Program
related policies and procedures. Such compliance is part of this position's performance
evaluation.
DUTIES AND RESPONSIBILITIES:
Care Navigation
1. Supports Care Team by:
i. Connects patients to social support services including transportation, food
resources, energy assistance programs, housing and others.
ii. Assist with connecting patients to specialty services including providing
patients with referral information and authorization to assistance with scheduling
and communication and other health literacy issues.
2. Ensure documentation in E.H.R. to maintain integrated information and
communication with Care Team.
3. Participate in huddles as appropriate to ensure communication with Care Team.
4. Conduct Health Assessment to develop more informed Health Action Plan to
assess patients' needs in the areas of physical health, mental health, SUD,
community-based Long Term Services & Supports, oral health, palliative care,
trauma-informed care, social supports, and housing (as appropriate for
individuals experiencing homelessness).
5. Ensure that provision of Health Action Plan services and implementation of
Health Action Plan are complete as they relate to care navigation and care
coordination.
6. Use motivational interviewing, trauma-informed care, and harm-reduction
practices to the care provided to patients and members.
Remote Patient Monitoring Program
Patient Care Navigator (PCN) Page 3
7. Administer Remote Patient Monitoring program for APHCV's Chronic Care
Management Program.
8. Monitor, track and report on distribution of RPM equipment
9. Provide and/or facilitate patient education on the use and care of the RPM equipment.
Care Coordination for AWV
10. Conduct outreach and schedule AWV appointments for APHCV Medicare
beneficiaries, both managed care and non managed care.
11. Coordinate referrals for Chronic Care Management services of Medicare
beneficiaries.
QUALITY IMPROVEMENTS AND QUALITY ASSURANCE
12. Participate in various QI and QA activities as assigned.
OTHER DUTIES
13. Any other duties CEO and/or DPI might assign.
Qualifications
Experience
- Required
- Associate's or Bachelor's degree
- Additional years of qualifying work experience may be considered in lieu
of degree
- Preferred
- Previous experience providing case management and/or care coordination
for vulnerable and/or underserved populations
Skills
- Required:
- Comfortable working with diverse populations.
- Exceptional ability to connect and engage with people.
- Ability to engage members
- Critical thinking skills & effective verbal and written communications skills
to consult with members, physicians, and providers
- Ability to use a personal computer and document care management
activities.
- Preferred
- Motivational interviewing,
- Current knowledge of clinical standards of care and disease processes.
- Knowledge of community resources in area of residence.
- Familiarity with trauma-informed care and harm reduction practices
Patient Care Navigator (PCN) Page 4
- Bilingual in one of LA County's Medi-Cal threshold languages is highly
desirable. (They are: English, Spanish, Chinese, Armenian, Arabic, Farsi,
Khmer, Korean, Russian, Tagalog, Vietnamese.)
HR Procedural requirements:
- Legal authorization to work in the United States
- A valid California Driver's license with clean records and access to insured
automobile
- Completion of APHCV Health Assessment Form
- Completion of DOJ background check
EMPLOYEE ACKNOWLEDGMENT:
I have read my job description and understand its contents. I agree to perform the
duties and responsibilities to the best of my ability. If at any time I have questions about
its contents, I will discuss with my supervisor any clarification. I have received a copy of
this job description and understand that it will be used to evaluate my performance both
on an ongoing basis and at regular intervals.
__________________________________
Employee's Printed Name
__________________________________ _____________________
Employee's Signature Date
___________________________________ _____________________
Supervisor's Signature Date

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