Patient Navigator

Neighborhood Health; Nashville (TN); On-site; USD 42,000 - 62,000; Full time

Job summary

Neighborhood Health in Nashville, TN is seeking a Patient Navigator to enroll members in TennCare, CoverRx, and the Federal Health Insurance Marketplace, and to coordinate care with our clinicians across multiple sites.

This full-time position reports to the Manager of Patient Navigation and focuses on serving underserved communities with compassionate outreach, accurate eligibility determinations, and seamless care coordination within a growing network of primary care centers.

Qualifications

• Bachelor’s or associate degree or equivalent experience.
• Qualifying full-time eligibility determination experience or clinical setting experience (3+ years).

Responsibilities

• Enroll uninsured/underinsured in TennCare, CoverKids, CoverRx and Marketplaces.
• Coordinate care between patients and practitioners; represent the organization at events.
• Maintain up‑to‑date knowledge of policies and procedures for eligibility.
• Complete required consumer assistance training and document activities.
• Assess client eligibility, explain benefits, and use systems to enter data.
• Provide support to ensure program integrity and client confidentiality.
• Identify resources to assist clients with insurance and health services.
• Develop relationships with referral sources and community resources.

Skills

Active listening

Communication (verbal and written)

Basic computer skills

Basic mathematical skills

Critical thinking

Organizational skills

Time management

Interpersonal skills

Spanish speaking

TennCare/CoverRx/Marketplace exp

Education

Bachelor’s or associate degree or experience equivalent

Job description

Neighborhood Health is an innovative network of 10 community health centers in Nashville, Lebanon, and Gallatin, Tennessee. We provide comprehensive primary care, integrated behavioral health, and dental services to almost 30,000 patients. Our patients primarily include immigrants, residents of public housing, individuals experiencing homelessness, and persons living with addiction. As a federally qualified health center, we provide care without regard to health insurance or a patient’s ability to pay. We also strive to improve our Patient Centered Medical Home (PCMH) model to ensure all of our patients get the right high-quality care, at the right place, and at the right time.

Neighborhood Health now seeks aPatient Navigator. This full-time employee will be responsible for two primary functions: enrollment in coverage programs and coordinating care for our members. This position will report to the Manager of Patient Navigation.

ThePatient Navigatorwill work within Neighborhood Health communities to enroll members in programs such as TennCare, CoverRx and the Federal Health Insurance Marketplace. Furthermore, it will be the responsibility of this individual to coordinate ongoing care between patients and practitioners. The Patient Navigator may also be required to represent Neighborhood Health at community events.

QUALIFICATIONS

Education and Experience

Graduation from an accredited college or university with a bachelor’s degree, associate’s degreeor experience equivalent.Qualifying full-time eligibility determination experience, experience in a clinical setting or similar experience at a professional, paraprofessional or technical level of three years or more.

Skills

Active listening and learning skills

Basic computer skills

Basic mathematical skills

Able to communicate effectively, both verbal and written, as appropriate for the needs of the audience.

Critical thinking, problem-solving and decision-making skills

Effective organizational and time management skills

Exceptional interpersonal skills

Spanish speaking preferred

Experience with TennCare, CoverRx and the Federal Health Insurance Marketplace is preferred

Abilities

Flexibility and adaptability to various environments and regulations

Able to be objective

Combines pieces of information to form conclusions

Communicates information and ideas in a manner tailored to the audience

Concentrates on tasks over a period of time without getting distracted

Multi-tasks with competing priorities

Retains information

Works as part of a team

Able to work with diverse population

ESSENTIAL JOB FUNCTIONS

• Ensures:
  • uninsured children and uninsured pregnant women apply for TennCare/CoverKids on or before their date of service;
  • uninsured parents/caretaker relatives of minor children under the federal poverty level apply for TennCare on or before their date of service;
  • uninsured adults age 18-64 under the federal poverty level apply for CoverRx on their date of service; and
  • Medicare enrollees who are at or below 135% of the federal poverty level apply for the Medicare Savings Program on their date of service.
• Ensures those patients ineligible for health coverage programs apply for and enroll in pharmacy patient assistance programs (PAPs) so these patients can obtain the prescription medications they need.

Remains up-to-date on new policies and procedures as they are implemented in order to ensure accurate eligibility determination and enrollment.

Successfully complete all required and applicable federal and/or state consumer assistance training.

Makes decisions by analyzing information related to client’s eligibility to ensure appropriate policy and procedures are applied.

Calculates accurate income based on information provided by clients and obtained through other sources to determine eligibility.

Documents required verifications, services, benefits provided, and other case-related activity using a computerized case record and/or paper case files.

Properly stores and maintains case related documentation to ensure program integrity and client confidentiality.

Documents reports of activities and outcomes as required.

Obtains documentary evidence to support client information to ensure proper eligibility determination.

Interviews clients to obtain information related to their eligibility for government assistance programs.

Explains eligibility for benefits and services, as well as ongoing responsibilities, to ensure client understanding.

Uses computer systems to enter client information to determine eligibility and ensure clients receive proper notifications.

Explains rules, regulations, policies, procedures, and benefits determinations to clients or other interested parties to ensure program availability.

Communicates verbally and/or electronically with outside organizations or vendors to provide information regarding client eligibility.

Care Coordination

Understands that Neighborhood Health is a Joint Commission Accredited facility and is obligated to abide by Joint Commission Standards.

Identifies clients with the potential for high-risk complications and coordinate the appropriate supported self-care in conjunction with the client and care coordination team.

Recognizes and takes appropriate actions to resolve gaps in care.

Develop and implement targeted strategies to improve health, functional or quality of life outcomes, such as disease management or pharmacy management.

Compare client’s plan of care to establish pathways to determine variances and then intervene as indicated.

Responsible for providing materials for morning huddle.

Enroll uninsured and underinsured patients in Patient Assistance Programs.

Meet with new clients to address questions or concerns during post-visit summary.

General

Resolves general client concerns regarding agency programs, policies, and procedures to assist customers.

Provides referrals to applicable offices to address client grievances, complaints or questions.

Provides information and assistance in a fair, accurate, culturally appropriate and impartial manner.

Enters required documents and information into various databases and filing systems for future retrieval.

Promotes a positive image of Neighborhood Health by focusing on great service while fulfilling the organization’s mission.

Communicates verbally and/or electronically with outside organizations to obtain information regarding client circumstances.

Provides information and support to co-workers, vendors, and clients to meet their immediate and long‑term needs.

Identifies benefits and services that might be available to clients both from the insurance exchange and from related sources to assist in meeting client needs.

Establish and maintain professional working relations with referral sources, community resources and care providers.

This list may not be inclusive of the total scope of job functions to be performed.

Duties and responsibilities may be added, deleted or modified at any time.

WORK SCHEDULE

40 hour work week. Must be willing to occasionally work nights or weekends.

SALARY GRADE AND CLASSIFICATION

Non-exempt, Full‑Time

SUPERVISORY RESPONSIBILITIES

None

RESPONSIBLE TO

Director of Enabling Services

PHYSICAL REQUIREMENTS

Work is varied in nature and is performed with frequent interruptions. Work requires close attention to detail, accuracy, documentation and timeliness in fulfilling duties and reports. Work requires sitting, standing, and/or walking for periods of five hours or more, moving and examining objects at high and low reach.