Care Navigator (Hybrid)

Alpine Physicians•Denver, CO

4d•Hybrid

About The Position

Are you looking to work for a company that has been recognized for over a decade as a Top Place to Work? Apply today to become a part of a company that continues to commit to putting our employees first. Position Summary: Responsibilities include: a) contractual outreach requirements to delegated populations such as Chronic Special Needs Programs (CSNP) ; b) supporting PHPprime Care Coordination programs in maximizing clinical outcomes for targeted populations; c) working collaboratively with community resource organizations, other PHP departments, facilities, health plans, and physician offices to provide optimal care coordination assistance and to promote efficiency and effectiveness in the whole spectrum of care coordination services offered; d) conducting telephonic and in-person or field-based care coordination and system navigation for members with physical and behavioral health needs; e) facilitating communication between members and indesciplinary care teams (ICT), including primary care, behavioral health providers, community organizations, and/or other members of the member’s ICT; f) initiating and completing care plans for physical and behavioral health, member identified goals and communicating care plan progress to primary care providers and ICT; and g) promotes quality assurance by ensuring that all contractually required care management chart elements are present

Requirements

High school diploma or GED required.
Minimum one to two years of customer service phone experience preferred.
Advanced computer skills utilizing Microsoft Excel, Word and Outlook.
Possess excellent customer service skills and ability to effectively interact with PHP personnel, medical and facility staff, other healthcare professionals and the general public.
Precise and detail oriented in managing, editing and communicating information through spreadsheets and computer systems.
Ability to work effectively and communicate with other teams and personnel within the PHP organization.
Skilled in conflict management, problem prevention and resolution.
Knowledge of medical terminology.
Able to accept and work with diverse populations and provide culturally sensitive education and assistance to patients/families.
Available to begin workday as early as 8 am.
A valid unrestricted Colorado drivers’ license.
Reliable and insured vehicle.
Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures.
Mobile Device for work purposes as defined by the company policies and procedures.

Nice To Haves

Bachelor’s degree, and/or experience in a Social work, or Behavioral Health realted field preferred.

Responsibilities

Contractual outreach requirements to delegated populations such as Chronic Special Needs Programs (CSNP)
Supporting PHPprime Care Coordination programs in maximizing clinical outcomes for targeted populations
Working collaboratively with community resource organizations, other PHP departments, facilities, health plans, and physician offices to provide optimal care coordination assistance and to promote efficiency and effectiveness in the whole spectrum of care coordination services offered
Conducting telephonic and in-person or field-based care coordination and system navigation for members with physical and behavioral health needs
Facilitating communication between members and indesciplinary care teams (ICT), including primary care, behavioral health providers, community organizations, and/or other members of the member’s ICT
Initiating and completing care plans for physical and behavioral health, member identified goals and communicating care plan progress to primary care providers and ICT
Promoting quality assurance by ensuring that all contractually required care management chart elements are present
Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.
Provides feedback and recommendations to leadership regarding Care Navigator duties and functions
Promotes communication among team to identify and streamline roles and responsibilities
Participates in meetings and presents information as needed
Effectively communicates both verbally and written with clients, members, and care coordination team
Reliably consumes instructions from leadership and asks clarifying questions
Reports on outcomes related Care Navigator initiatives
Communicates professionally with providers, physicians, and other healthcare professionals
Accurately coordinates referrals to other team members by: a) assessing for level of urgency and level of risk; b) reviewing, documenting, and determining appropriate level of care; and c) creating appropriate case requests
Implements appropriate intervention(s) in a timely manner to assure problem prevention and resolution
Identifies, develops, and utilizes community resources appropriately
Uses motivational interviewing to achieve desired outcomes for the member
Effectively navigates systems in order to obtain information needed for specialized projects
Meets case workload and documentation requirements as defined by department standards
Contributes to the Care Coordination team through staff meeting attendance and participation, lending assistance to co-workers and other PHP similar activities
Tracks and reports results of outreach projects and co-location activities
Monthly and ad-hoc reporting duties as assigned
Single Point of Contact for co-location and/or clinical care coordination program
Has ability to receive feedback and apply it to work performance
Identifies opportunities for, and participates in, continuing education including workshops, conferences, specific publications, etc.
Develops strong relationships with members to include handling escalated members and/or members with high acuity and high intensity needs
Advocates on behalf of members with providers, specialists and community agencies
Follows up with high acuity and high intensity members to ensure their needs are met
Acts as the subject matter expert for Care Navigator initiatives to assure best practices in outreach, engagement and communication
Understands and effectively utilizes “specialized” resources
Understands integrated care coordination program requirements
Maintains confidentiality and ensures compliance with HIPAA regulations
Other duties as assigned