Patient Navigator-2

ChenMed•Miami Gardens, FL

1d•$19 - $26•Remote

About The Position

The Patient Navigator I (Tier 1) is a non-clinical, patient-facing role handling first-touch tickets across three Patient Navigation workstreams: Non-CPL/Out-of-Network Requests, Care Plan Non-Adherence, and Voluntary PCP Switches. Working in a centralized call center with calls that are fully recorded and monitored, the navigator contacts patients by phone to understand requests, explain relevant options, resolve issues within the role’s scope, or route and escalate cases appropriately. The role is the primary voice for most patient interactions and requires strong interpersonal and persuasive skills, careful documentation, and adherence to compliance requirements. The Patient Navigator does not make clinical determinations or utilization-management decisions and must process voluntary PCP-change requests without retention pressure. The position helps patients understand ChenMed’s care model, including personalized care plans, in-house specialty care, and its coordinated provider ecosystem.

Requirements

Demonstrated success in persuasion, influence, and customer service; healthcare, health plan, or member-services experience is desirable.
Ability to engage patients empathetically while adhering to compliance guardrails, including not pressuring patients who want to leave the practice and not offering clinical opinions outside the role’s scope.
Strong active-listening and de-escalation skills, with the ability to remain calm and professional with frustrated or distressed callers.
Meticulous documentation habits and comfort working in a fully recorded, closely audited call environment.
Sound judgment in recognizing when a case requires escalation.
Commitment to maintaining the highest level of confidentiality, including HIPAA requirements.
Excellent verbal communication skills and a clear, professional phone presence.
Proficiency in Microsoft Office and standard case-management or CRM software, with the ability to type and document accurately during active calls.
Ability to work independently and as part of a team in a fast-paced, metrics-driven environment.
Fluency in spoken and written English.
High school diploma or equivalent.
One to two years of experience in customer service, a call center, or a patient-facing administrative healthcare role.

Nice To Haves

Basic understanding of Medicare Advantage concepts, including PCP attribution and coordinated/in-network provider lists; willingness and ability to learn is required.
Bilingual proficiency in Spanish or another language relevant to the patient population.
Associate’s degree or relevant certification.
Prior experience in a Medicare Advantage, managed care, or medical office setting.
Experience with CRM or case-management software.

Responsibilities

Handle inbound and outbound tickets across Non-CPL/Out-of-Network Requests, Care Plan Non-Adherence, and Voluntary PCP Switches through the centralized intake queue.
For Non-CPL/Out-of-Network Requests, explain available in-network and CPL-coordinated options and encourage their use without making coverage or network-exception determinations.
For Care Plan Non-Adherence, conduct supportive first-touch outreach to understand straightforward barriers and escalate clinical barriers, safety concerns, or informed-refusal documentation needs to a Tier 2 RN or Licensed Social Worker.
Process voluntary PCP-change requests promptly and without retention pressure, initiating attribution changes, record transfers, and required documentation accurately and within required timeframes.
Document every case in the centralized case-management system, including outreach attempts, call content, outcomes, and escalations, to CMS delegation-oversight audit standards.
Recognize cases outside Tier 1 scope or the three workstreams and route them to the appropriate owning team.
Maintain a professional, composed, and empathetic tone on recorded and monitored calls and meet ongoing quality review standards.
Meet productivity and quality standards for call volume, average handle time, and documentation completeness as defined by the Manager, Patient Navigation.
Participate in ongoing training on CMS compliance topics and script and process updates.
Perform other duties as assigned or modified at the manager’s discretion.