Patient Care Navigator

at  ValleyWide Health Systems Inc

Valley-Wide Health Systems, Inc. (Valley-Wide) welcomes and is committed to all patients and populations within our large multi-county service area throughout southern Colorado. As a non-profit, Federally Qualified Health Center (FQHC), we provide premier primary and preventive care you can trust at our 34 service sites strategically located throughout multiple rural counties.
At Valley-Wide Health Systems, our Patient Care Navigators are essential in providing proactive support to care teams, patients, and staff. In this dynamic role, you will connect patients with services that best meet their needs, reducing barriers to healthcare and effectively directing them to resources that optimize their health status.
You will foster a culture of patient and family-centered care, ensuring excellence in service, quality, and safety. Your work will not only improve patient experiences but also enhance employee engagement and strengthen community relations. We prioritize your professional growth, empowering you to develop your skills while making a meaningful impact on the lives of those we serve. Join us in shaping the future of healthcare and advancing your career in a role that values your dedication to quality care and holistic patient support.

EDUCATION/TRAININGS/CERTIFICATES:

• High School Diploma required. Bachelors Degree in Business/Healthcare Administration, human services, social work or related field preferred OR one (1) year of qualifying experience.
• Bilingual Spanish-speaking is preferred

• Assist patients in problem solving potential issues related to the health care system, financial or social barriers
• Will assist with enrollment applications for appropriate programs (e.g. Senior Dental, Medicaid, Sliding Fee Discount Program, MedRide, etc.)
• Will request interpreters as appropriate, transportation services or prescription assistance
• Collect and verify documentation and information to support eligibility and enrollment for State or local programs and slide discount programs.
• Must maintain confidentiality of all information received from patients/clients.
• Complete a comprehensive assessment of all new and referred patients by exploring clinical needs, psychosocial needs and social determinants of health (SDoH) to assist in effective health maintenance, adjustment, and improvement of patient health outcomes.
• Participate in a medical home model of care using a team-based approach, including helping patients identify a Primary Care Provider, participate in Team Huddles, and develop and evaluate progress with individual health care plans and goal-setting.
• Orient all new and referred patients to assist with adjustment processes including understanding medical/dental recommendations, decision-making regarding care management, options for care and all of the services available at Valley-Wide.
• Be familiar with and understand requirements for applicable internal and community programs
• Close the loop on external and internal referrals for services
• Provide Health Navigation and Assistance with Medical Referral Services and Specialty Dental Services
• Complete pre-authorization in accordance to patients payer source requirements.
• Schedule Imaging and Diagnostics with Performing Entity
• Keep patient informed and provide timely response to patients on the status of obtaining prior authorization from insurance companies.
• Monitor and track all pre-authorizations submitted, approved, and pending, follow up as needed and document progress.
• Follow-up on any denied authorization requests, determine the reason for denial and if additional information is required for re-submission and facilitate an appeal if appropriate
• Facilitate and coordinate patient care by reviewing and monitoring treatment plans and appropriate documentation to assist patient in understanding. Contact insurance companies to verify coverage and extent of benefits
• Collect and maintain required records for all program enrollments and assist with collection of records for audits.
• Provide Health Navigation and Assistance with Referral Services
• Assist in navigating any barriers for all patient referrals for patients and their families
• Proactively collaborate with an interdisciplinary healthcare team, internal and external to the clinic
• Build and use effective communication and motivational interviewing skills among patients, family members, specialists, community professionals and others associated with the patients care plan.
• Document all navigation activities in the Electronic Health Record and other databases as required, including social determinants of health screening, Recent ER Visits, Recent Hospitalizations, Care Team, and SOAP notes.
• May be assigned specific population health management tasks for identified populations
• Achieve and maintain any necessary or required certifications and trainings for the services provided in this role.
• Run assigned GAP reports and provide support to the clinical teams and patients to schedule preventive and routine exams to assist with meeting organizational quality improvement goals
• In clinics without a Pod Support position or when the clinic needs this assistance:
• Assists Patients Calling or Visiting the Clinic by
• Manage patient portal requests and schedule appointments appropriately.
• Schedule patients for follow-up appointments before leaving the clinic.
• Work with Clinic Manager to provide necessary access to patients.
• Performs appropriate documentation of patient information in RedCap system.
  Experience: 1+ year of customer service, support, coordination or case management experience