Care Navigator

Greater Good Health•Victorville, CA

14h•$25 - $26•Remote

About The Position

The GGH Care Navigator plays a critical role as the primary point of contact for engaging patients, coordinating their care across settings, and connecting them to the right resources at the right time. Successful Care Navigators are excellent communicators, empathetic, and have a strong work ethic and desire to positively impact the quality of care delivered by GGH. They are welcoming and courteous, possess superior active listening and critical thinking skills, and are comfortable with multitasking and problem-solving. Care Navigators serve as patient advocates — removing barriers to care, supporting patients through complex health journeys, and ensuring that no patient falls through the cracks. They must also be skilled at relating to the geriatric population, building trust, and making patients feel supported at every step of their healthcare experience. Applicants must be comfortable working 8a 5p (PST).

Requirements

1–2 years of post-high school education or an associate’s degree; bachelor’s degree in health sciences, social work, public health, or a related field is a plus.
1–3 years of experience working in standard operating systems (Windows, MS Word, MS Excel, Internet, and other applicable software).
1–3 years of experience in a patient-facing healthcare role.
Excellent verbal and written communication skills, including the ability to communicate complex health information in an accessible and empathetic way.
Outstanding phone skills with sensitivity toward protected health information (PHI) and HIPAA compliance.
Familiarity with medical terminology and basic understanding of chronic disease management in older adults.
Must be organized, detail-oriented, and able to multitask in a fast-paced care coordination environment.
Must be adaptable, a team player, and comfortable working both independently and collaboratively.
Professionalism in appearance, communication, and demeanor.
Solid critical thinking and problem-solving skills with the ability to manage complex, multi-step patient situations.

Nice To Haves

Healthcare experience in a patient-facing or care coordination role (Strongly Preferred).
Experience with or training in motivational interviewing, health coaching, or behavioral change techniques.
Experience retrieving medical records from hospitals, EHR systems, or external providers.
Familiarity with post-discharge care workflows, transitions of care, or case management principles.
Experience with value-based care models, population health management, or Medicare Advantage programs.
1+ years of experience working with Medicare or senior/geriatric populations.
Experience with HEDIS gap closure or quality improvement initiatives.
1+ years of call center experience and managing phone queues.
Basic Excel skills: navigation, data entry, filtering, and sorting.
Knowledge of or experience with EHR/EMR platforms.
Certification in care coordination, patient navigation, or a related area (e.g., CCM, ACM, CPHQ) is a plus.
Strong preference for bilingual candidates (English/Spanish).

Responsibilities

Conduct proactive outreach to schedule patient home, telehealth, and in-clinic visits to complete Annual Wellness Visits (AWVs), ensuring patients receive timely preventative care and individualized care plans.
Accept inbound calls from patients to schedule AWVs and address care-related questions or concerns.
Connect with the geriatric population to build trusting, long-term relationships — making patients feel calm, comfortable, and heard throughout their care experience.
Identify and address barriers to engagement, including transportation, language, health literacy, financial hardship, and other social and environmental factors.
Outreach to patients to complete key preventative screenings (colon cancer, mammograms, diabetic retina scans, HbA1c, and more), documenting outreach and establishing follow-through plans.
Partner closely with assigned GGH Nurse Practitioners (NPs) to co-manage their patient panel, serving as the day-to-day coordination hub for scheduling, care follow-through, and patient communication.
Build and optimize driving routes for GGH Nurse Practitioners completing home visits, maximizing time spent with patients.
Coordinate patient cancellations, reschedules, and add-on visits with the NP to ensure continuity of care and efficient schedule management.
Retrieve and reconcile medical records from outside providers, hospitals, health systems, and community organizations to ensure the care team has a complete and current view of each patient’s health history.
Manage patients post-discharge from hospital or skilled nursing facility settings, coordinating timely follow-up visits and facilitating care plan transitions to reduce readmission risk.
Follow up with patients on outstanding provider orders — including lab work, imaging, specialist referrals, and durable medical equipment — ensuring completion and routing results back to the care team.
Coordinate referrals and activities for high-risk programs, facilitating smooth transitions between care settings and service providers.
Support the care team in identifying and closing quality gaps, including HEDIS measures and chronic disease management needs.
Handle protected health information (PHI) with discretion, adhering to HIPAA standards and GGH privacy policies at all times.
Maintain timely, accurate, and thorough documentation of all patient interactions, outreach attempts, care coordination activities, and follow-up plans.
Build strong, positive working relationships with GGH Nurse Practitioners and the Patient Outreach Team, and maintain professional communications with client partners and the broader care team.
Participate in interdisciplinary care team meetings, contributing patient updates and coordinating action steps across team members.
Maintain collaborative relationships with clinicians and the leadership team to support the development of new programs aimed at improving patient engagement, care coordination, and health outcomes.
Other duties as assigned.