Patient Navigator-2

ChenMed

1d•$19 - $26•Remote

About The Position

The Patient Navigator I (Tier 1) is a non-clinical, patient-facing role that handles first-touch tickets across three 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 recorded and monitored, the navigator contacts patients by phone to understand their requests, explain relevant options, resolve matters within the role’s scope, or route them to the appropriate next step, including escalation to Tier 2 resources when needed. The position serves as a primary voice for many patient interactions and requires strong interpersonal and persuasive skills alongside rigorous documentation. Navigators do not make clinical determinations or utilization-management decisions, and they must process voluntary PCP changes without retention pressure. The role supports patients in understanding 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 ideal.
Ability to communicate empathetically while adhering to compliance requirements, including avoiding pressure on patients who wish to leave the practice and avoiding 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 confidentiality and HIPAA standards.
Excellent verbal communication skills and a clear, professional phone presence.
Proficiency in Microsoft Office and standard case-management or CRM software, with accurate typing and documentation during active calls.
Ability to work independently and collaboratively 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.
Bilingual proficiency in Spanish or another language relevant to the patient population.
Associate’s degree or relevant certification.
Prior experience in Medicare Advantage, managed care, or a 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 out-of-network requests, explain available in-network and CPL-coordinated options without making or influencing coverage or network-exception determinations.
For care-plan non-adherence, conduct supportive first-touch outreach, address 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; initiate attribution changes, record transfers, and required documentation accurately and within required timeframes.
Document each case in the centralized case-management system, including outreach attempts, call content, outcomes, and escalations, to standards required for CMS delegation-oversight audits.
Identify cases outside Tier 1 scope or the three specified workstreams and route them to the appropriate owning team.
Maintain a professional, composed, and empathetic tone on recorded and monitored calls, meeting ongoing quality-review expectations.
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 relevant CMS compliance topics and script or process updates.
Perform other duties as assigned and modified at the manager’s discretion.