Patient Care Navigator II

COPE Health Solutions•Downey, CA

58d•$23 - $27

About The Position

The Patient Care Navigator II (PCN II) is the initial point of contact for the Enhanced Care Management (ECM) team and conducts outreach to members referred to the program in community settings, at community agencies and hospitals, and by phone. The role leads initial screening, eligibility verification, and program enrollment. The PCN II also orients and onboards new Patient Care Navigators, helps organize community outreach, develops relationships with referral partners, and raises awareness of ECM in the community. Navigators do not carry a caseload or provide ongoing care coordination; after enrollment, the Navigator makes a warm handoff to the assigned Lead Care Manager. The position involves substantial field-based outreach across the listed Los Angeles-area locations, with 80% travel. The PCN II works with members, referral partners, and a multidisciplinary care team to support outreach, enrollment, and transition into ECM services.

Requirements

High school diploma or equivalent.
At least one year of experience in community outreach and enrollment, care coordination, community health work, case management, or social services.
Demonstrated success meeting outreach or enrollment targets.
Experience working with high-risk or vulnerable populations.
Strong interpersonal, organizational, and communication skills, including public speaking and presenting to community groups and partners.
Ability to build and maintain relationships with community partners and referral sources.
Ability to train, mentor, and support peers.
Ability to manage high-volume outreach and prioritize multiple tasks in a fast-paced environment.
Comfort with field-based, community, and home visits.
Proficiency with electronic health records and care management platforms.
Reliable transportation with active insurance coverage and a valid California driver’s license.
Ability to work occasional evenings or weekends for community events.

Nice To Haves

Associate’s or bachelor’s degree in health administration, public health, social work, sociology, psychology, or a related field.
Two years of experience in community outreach and enrollment, care coordination, community health work, case management, or social services preferred.
Experience working within CalAIM, ECM, managed care, or Medicaid programs.
Experience training, onboarding, or mentoring staff.
Experience planning community outreach events or presentations.
Knowledge of community-based resources and social service systems, including Los Angeles County referral networks.
Community Health Worker (CHW) certificate or training.
Lived experience in, or familiarity with, the communities and populations served.
Bilingual abilities.

Responsibilities

Conduct timely telephonic and in-person outreach to members referred or authorized for ECM, using approved scripts and contact methods including phone, text, mail, and in-person visits.
Conduct community outreach at clinics, hospitals, shelters, community agencies, and members’ homes, including efforts to locate members who are difficult to reach by phone.
Explain ECM services and benefits, answer questions, address concerns, and use culturally and linguistically appropriate, trauma-informed approaches and motivational interviewing.
Vary outreach timing, location, and methods; follow up on unsuccessful contacts according to program standards and timelines.
Support complex or hard-to-reach outreach, including for members experiencing homelessness or significant behavioral health or substance use needs.
Screen members for ECM eligibility and Populations of Focus; verify Medi-Cal eligibility, health plan assignment, and ECM authorization status.
Obtain consent and complete enrollment forms and intake documentation accurately and on time.
Track member status through outreach and enrollment and follow up on pending enrollments.
Connect members with community resources and social services, and escalate urgent needs or safety concerns to the ECM care team according to protocol.
Plan and coordinate community outreach activities, partner site visits, health fairs, and community events.
Build and maintain relationships with referral partners and serve as a contact for assigned partners and referral sources.
Present information about ECM eligibility, benefits, and referral pathways to community partners and provider staff.
Respond to referral questions, resolve referral issues, track outreach and enrollment trends, and recommend ways to strengthen referral pipelines and enrollment outcomes.
Maintain an inventory of community resources and partner contacts.
Orient and onboard new Patient Care Navigators through shadowing, field ride-alongs, and review of scripts, eligibility criteria, workflows, and documentation standards.
Serve as a peer resource on ECM eligibility, outreach practices, and enrollment workflows; review new Navigators’ documentation during onboarding and share observations with the ECM Program Manager.
Help update outreach scripts, job aids, and training materials.
Complete a warm handoff of each newly enrolled member to the assigned Lead Care Manager and ensure enrollment information is complete and the member understands next steps.
Assign members to appropriate Lead Care Managers based on risk category and available clinical data, in coordination with the ECM Program Manager.
Collaborate with RNCMs, LVNs, BHCMs, CHWs, and other care team members regarding referrals, enrollment status, and member transitions.
Communicate with the ECM Program Manager about referral volume, enrollment status, and outreach barriers.
Maintain timely and accurate documentation in the ECM care management platform, including outreach attempts, screenings, consents, and enrollment activities.
Meet established outreach productivity and enrollment targets; protect member privacy and comply with HIPAA and organizational policies.
Participate in quality improvement initiatives, attend provider, health plan, community partner, and internal meetings, and represent the ECM program at community and partner meetings.
Provide coverage for team outreach and enrollment activities and complete additional tasks and projects that support ECM program goals.