Care Navigator - Family Medicine Breckinridge
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About The Position
The Care Navigator for Family Medicine at Owensboro Health is responsible for overseeing care management and coordination activities for patients within a primary care practice. This role involves working closely with clinical teams to enhance patient care through effective pre-visit planning and post-visit follow-up. The Care Navigator engages patients in their health improvement activities and educates them on self-management tasks, empowering them to take control of their health status. Collaboration with physician leadership is essential to develop protocols and point-of-care reminders based on nationally recognized evidence-based care (EBC) measures and outcomes. In this position, the Care Navigator defines quality measures and reporting processes, serving as a resource for clinical staff and providers to establish quality goals using data reports. The role also requires working with IT resources to facilitate registry reporting and ensure that documentation of EBC is accessible and efficient. The Care Navigator manages a panel of chronic care patients, providing follow-up contact to ensure compliance with treatment recommendations, including medications, lab tests, and specialist visits. The Care Navigator plays a critical role in managing various aspects of patient care, including referrals to specialists, hospitalizations, and emergency visits. They provide telephone advice according to established protocols and handle urgent calls. Additionally, the Care Navigator collaborates with patients and their care teams to assess readiness for change, conduct needs assessments, and develop individualized treatment care plans. They assist patients in setting SMART goals for self-management and teach them how to perform self-management tasks effectively. The position also involves assessing barriers to treatment adherence and overseeing the development of educational resources for patient self-management. The Care Navigator collaborates with payer Care Managers for additional services and maintains relationships with community resources to support patient needs. They facilitate communication between primary care physicians and consulting specialists, ensuring effective coordination of care and follow-up processes. Overall, the Care Navigator is integral to enhancing patient care and outcomes within the primary care setting.
