FHC Patient Navigator

University of California San Francisco•San Francisco, CA

About The Position

The Patient Navigator will support the clinical and logistical needs of two specialty clinics within the Family Health Center at ZSFG: the Bridge Clinic (50%) and the Gender Affirming Care Clinic (50%). This role is essential to the expansion of clinic services, joining a team of existing Navigators working in both settings. The Navigator will serve as a critical bridge between patients and healthcare services, helping to improve care access, continuity, and outcomes for both populations. Bridge Clinic Responsibilities (50% Time) The Bridge Clinic supports patients who use drugs, alcohol, or tobacco. People with substance use disorders often need support transitioning from acute care to ongoing community-based services. These patients have traditionally had low rates of follow-up after acute care referrals, and the Navigator plays a critical role in improving linkage rates. Emergency Department (ED) Identify and screen patients for substance use disorder Provide motivational interviewing and harm reduction counseling Develop outpatient follow-up plans and provide referrals (medication treatment clinics, residential programs, detox, community resources) Support ED initiation of addiction medications Distribute harm reduction supplies (syringes, naloxone) Round with Social Medicine team Bridge Clinic Partner with physicians, social workers, and pharmacy to support patients Discuss and facilitate referrals to behavioral health and residential treatment Provide harm reduction services Schedule appointments and conduct phone outreach for continuity of care General Responsibilities Maintain patient support phone line during business hours Track data and operational metrics Complete EHR documentation and panel management Lead quality improvement projects Complete administrative duties during designated time Gender Affirming Care Clinic Responsibilities (50% Time) The Gender Affirming Care Clinic serves as part of a comprehensive longitudinal curriculum for family medicine residents focused on primary and specialized care for patients across the gender spectrum. Along with patient support, the Navigator will also have responsibilities related specifically to the NIH grant supporting curriculum development. Patient Support & Navigation (30%) Serve as a non-clinical resource and liaison for TGD patients and their families when applicable Provide panel management oversight to ensure care gaps are being met for the gender diverse patient population Help patients navigate the complex healthcare system and connect with community resources Liaison with Gender Health SF to facilitate improved coordination of care Use knowledge of the clinic to resolve issues and support patient needs Track relevant data and operational metrics for reporting across both clinics Complete electronic health record documentation Quality Improvement & Patient Engagement (10%) Conduct and review surveys and focus groups with transgender/gender diverse (TGD) patients to recommend changes in clinic structure and services Identify ways to increase patient satisfaction for TGD patients, both adults and children Assist with quality improvement efforts to enhance care for gender diverse individuals Assist in communicating with members of the Patient Advisory Committee Coordinate Patient Advisory Committee meetings (approximately four evening commitments per year) Education & Resource Development (10%) Develop and maintain a library of resources and orientation information for patients Support resident education on the healthcare needs of gender diverse individuals Help write up best practices for teaching clinics serving gender diverse patients as part of the curriculum package for dissemination Assist in disseminating best practices to other teaching clinics

Requirements

Bachelor's degree in related area and / or equivalent experience / training
Minimum 3 years of related experience
Strong interpersonal and customer service skills.
Ability to communicate and resolve issues effectively with a diverse population of patients, staff and physicians
Strong knowledge of transgender health care needs.
Background understanding of health disparities, especially as they apply to the LGBTQ population
Excellent analytical and problem-solving skills.
Ability to develop solutions and recommend changes and follow-through with implementation
Ability to work independently in a fast-paced, demanding environment with minimal supervision
Ability to manage and oversee multiple tasks simultaneously, including high daily call volume
Demonstrated ability to work independently and in a team; excellent demonstrated record of attendance and punctuality
Excellent written and verbal communication skills by email, phone, and text
Proficiency with Windows-based software including Microsoft word, Excel, Outlook.
Knowledge of computer systems and software used in functional area
Strong knowledge of Patient Rights & Responsibilities, Joint Commission standards, and Centers for Medicare / Medicaid regulations.
Knowledge of Medical Terminology.
Strong knowledge of data collection, compilation, and analytical techniques
Strong skills to comprehend and assess patient's grievances to quickly locate appropriate resource for assistance.
In-depth knowledge of the organization and how to get issues resolved
Ability to create effective rapport with a diverse group of patients and care providers

Nice To Haves

Proficiency in Spanish
Excellent analytical, interpersonal, and problem-solving skills
Experience working with electronic health records
Knowledge of evidence-based treatment for substance use disorders
Knowledge of harm reduction principles and skills
Knowledge of San Francisco’s mental health, substance use, and community-based organization services; and/or community-based organization services for transgender/gender diverse individuals
Proficiency with motivational interviewing
Experience working in medical settings with ability to further learn concepts and terminology pertinent to medical and mental health services
Knowledge of personal recovery from substance use disorders

Responsibilities

Identify and screen patients for substance use disorder
Provide motivational interviewing and harm reduction counseling
Develop outpatient follow-up plans and provide referrals (medication treatment clinics, residential programs, detox, community resources)
Support ED initiation of addiction medications
Distribute harm reduction supplies (syringes, naloxone)
Round with Social Medicine team
Partner with physicians, social workers, and pharmacy to support patients
Discuss and facilitate referrals to behavioral health and residential treatment
Provide harm reduction services
Schedule appointments and conduct phone outreach for continuity of care
Maintain patient support phone line during business hours
Track data and operational metrics
Complete EHR documentation and panel management
Lead quality improvement projects
Complete administrative duties during designated time
Serve as a non-clinical resource and liaison for TGD patients and their families when applicable
Provide panel management oversight to ensure care gaps are being met for the gender diverse patient population
Help patients navigate the complex healthcare system and connect with community resources
Liaison with Gender Health SF to facilitate improved coordination of care
Use knowledge of the clinic to resolve issues and support patient needs
Track relevant data and operational metrics for reporting across both clinics
Complete electronic health record documentation
Conduct and review surveys and focus groups with transgender/gender diverse (TGD) patients to recommend changes in clinic structure and services
Identify ways to increase patient satisfaction for TGD patients, both adults and children
Assist with quality improvement efforts to enhance care for gender diverse individuals
Assist in communicating with members of the Patient Advisory Committee
Coordinate Patient Advisory Committee meetings (approximately four evening commitments per year)
Develop and maintain a library of resources and orientation information for patients
Support resident education on the healthcare needs of gender diverse individuals
Help write up best practices for teaching clinics serving gender diverse patients as part of the curriculum package for dissemination
Assist in disseminating best practices to other teaching clinics