Care Navigator, Enrollment Partner – Care Transitions

Avail Health•Rockville, MD

7d•Onsite

About The Position

Avail Health is seeking a compassionate, relationship-driven Care Navigator, Enrollment Partner to serve as our primary onsite representative within a hospital setting. In this role, you’ll help patients make a smooth transition from hospital to home by identifying eligible patients, introducing Avail Health’s Care Transitions Program, facilitating enrollment, and ensuring every patient leaves the hospital with a clear plan and a scheduled follow-up appointment. As the first face many patients and caregivers encounter from Avail Health, you’ll play a critical role in building trust, creating a positive patient experience, and strengthening our partnership with hospital teams. This position is ideal for someone who enjoys connecting with people, thrives in a fast-paced healthcare environment, and is passionate about improving care for older adults and individuals with complex medical and behavioral health needs. As part of a rapidly growing organization, you’ll also have the opportunity to influence workflows, improve patient engagement strategies, and help shape the future of our Care Transitions Program.

Requirements

High school diploma required; Associate’s or Bachelor’s degree preferred.
Two or more years of experience in healthcare patient engagement, care coordination, patient access, practice operations, community outreach, or related healthcare operations.
Experience enrolling patients into healthcare programs or value-based care initiatives.
Strong interpersonal skills with the ability to establish trust and build rapport quickly.
Demonstrated commitment to exceptional customer service and compassionate, patient-centered care.
Excellent organizational and time management skills.
Comfort working with patients experiencing complex medical, behavioral health, cognitive, and psychosocial needs.
Proficiency using electronic medical records, scheduling systems, Microsoft Office, and multiple technology platforms.
Ability to work independently while collaborating effectively with interdisciplinary teams.

Nice To Haves

Community Health Worker (CHW) certification or comparable experience.
Experience as a Care Navigator or Health Coach.
Healthcare outreach, enrollment, or patient engagement experience.
Hospital, physician practice, home health, hospice, post-acute, or population health experience.
Experience scheduling healthcare appointments.
Familiarity with Medicare Advantage or other value-based care programs.
Experience working in startup or rapidly growing healthcare organizations.
Bilingual language skills.

Responsibilities

Building trusted relationships with patients, caregivers, and hospital care teams from the very first interaction.
Identifying eligible patients and successfully enrolling them into Avail Health’s Care Transitions Program before hospital discharge.
Creating a seamless, patient-centered transition from hospital to home through thoughtful coordination and communication.
Serving as Avail Health’s onsite ambassador while strengthening hospital partnerships and referral relationships.
Ensuring every enrolled patient has completed documentation, required consents, and a scheduled follow-up appointment before discharge.
Identifying workflow improvements that enhance patient engagement, operational efficiency, and program growth.
Serve as Avail Health’s primary onsite representative within the assigned hospital.
Partner with hospital care navigation teams to identify patients who may benefit from the Care Transitions Program.
Meet with patients and caregivers to explain the program, answer questions, and build confidence in Avail Health’s services.
Facilitate enrollment, obtain required consents, and complete enrollment documentation.
Schedule each patient’s initial Care Transitions appointment before discharge.
Coordinate warm handoffs between hospital staff and Avail Health’s interdisciplinary care team.
Communicate enrollment status and operational updates to virtual clinical team members.
Escalate clinical questions or concerns to Care Transitions RN or Social Work Care Managers as appropriate.
Maintain accurate documentation within hospital systems, Avail Health’s EHR, and operational platforms.
Participate in workflow improvements that strengthen hospital partnerships and improve the patient experience.