Plan Care Navigator: Care Coordination & RPM Support

Pruitthealth Corporation; Athens (GA); On-site; USD 48,000 - 60,000; Full time

Job summary

PruittHealth Corporation in Georgia seeks a Plan Care Navigator to coordinate care for members in the Premier program and perform structured phone assessments. You will monitor health status, document in EHR, and help close gaps in care to improve outcomes.

The role requires strong communication, organizational skills, and the ability to manage referrals, scheduling, and patient education while adhering to HIPAA and clinic protocols.

Qualifications

• Understanding of referral and prior authorization processes.
• Knowledge of PruittHealth Premier Plan policies and procedures.
• Familiarity with CMS regulations and Model of Care requirements.
• HIPAA compliance and medical data security awareness.
• Proficiency with EMR, care management platforms, Microsoft Office, and reporting.
• Excellent communication and interpersonal abilities.
• Strong organizational skills to handle high call volumes.
• Ability to prioritize multiple assignments in clinical settings.
• Analytical, problem-solving, and collaborative capabilities.

Responsibilities

• Handle inbound calls, assess member needs, and provide guidance.
• Provide live phone support to answer questions before appointments.
• Coordinate care workflows from outreach to case resolution.
• Escalate clinical concerns to RNs per protocol.
• Document interactions in EHR; utilize call-center scripts.
• Conduct check-in calls to review symptoms and medications.
• Review care plans with patients under supervision of a provider.
• Coordinate services between PCPs, specialists, labs, and other providers.
• Assist with scheduling, refills, and tracking referrals.
• Assist with scheduling transportation and durable medical equipment pickup
• Complete welcome calls and health risk assessments
• Support interdisciplinary team meetings
• Monitor health data and clarify RPM readings
• Escalate urgent updates to supervising staff as needed
• Guide patients to resources and referrals to specialty care
• Maintain HIPAA-compliant data privacy across digital touchpoints

Skills

Referral & prior authorization

PruittHealth Premier Plan knowledge

CMS regulations

HIPAA compliance

EMR & care management tools

Microsoft Office & reporting

Communication skills

Organizational skills

Multitasking & prioritization

Analytical & problem-solving

Education

High School diploma or GED

Associate degree or health sciences / CMA or related coursework

Tools

EMR system

Care management platform

Job description

PruittHealth Corporation in Georgia seeks a Plan Care Navigator to coordinate care for members in the Premier program and perform structured phone assessments. You will monitor health status, document in EHR, and help close gaps in care to improve outcomes.

The role requires strong communication, organizational skills, and the ability to manage referrals, scheduling, and patient education while adhering to HIPAA and clinic protocols.