Patient Navigator-2

ChenMed

1d•$19 - $26•Remote

About The Position

The Patient Navigator I (Tier 1) is a non-clinical, patient-facing role responsible for the first-touch handling of tickets across Patient Navigation's three Phase 1 workstreams: Non-CPL (Coordinated Provider List) /Out-of-Network Requests, Care Plan Non-Adherence, and Voluntary PCP Switches. Operating within a centralized, 100%-recorded and monitored call center model, the Patient Navigator I engages patients directly by phone to understand their request, explain relevant options, and either resolve the ticket directly or route it to the appropriate next step — including escalation to a Tier 2 resource to support when appropriate (Supervisor, Clinical Leadership, or Network Leadership). This role is the primary voice of this role is for most patient interactions and is expected to combine strong interpersonal and persuasive skills with rigorous documentation discipline, given the compliance-sensitive nature of the function. The Patient Navigator I does not make clinical determinations, does not perform utilization management decisions, and does not apply retention pressure to patients requesting a PCP change — CMS treats PCP selection as a protected member right, and this role is expected to process such requests without friction. Above all, this role serves to ensure that patients fully understand how ChenMed’s model for simplifying complex care through the development of personalized care plans, using in-house specialty care, and working within our trusted coordinated provider ecosystem delivers more good days.

Requirements

Demonstrated success in persuasion, influence, and customer service, ideally within a healthcare, health plan, or member-services environment.
Ability to engage patients empathetically while strictly adhering to compliance guardrails — including never pressuring a patient who wants to leave the practice, and never offering a clinical opinion outside the scope of the role.
Strong active-listening and de-escalation skills; 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, rather than attempting to resolve it independently.
Basic understanding of Medicare Advantage concepts (PCP attribution, coordinated/in-network provider lists) preferred; willingness and ability to learn required.
Understands and is committed to maintaining the highest level of confidentiality (HIPAA).
Excellent verbal communication skills; clear, professional phone presence.
Proficient in Microsoft Office and standard case-management/CRM software; ability to type and document accurately while on an active call.
Ability to work effectively independently and as part of a team in a fast-paced, metrics-driven environment.
Spoken and written fluency in English required; bilingual proficiency (Spanish or another language relevant to the patient population) a plus.
High school diploma or equivalent required; Associate's degree or relevant certification preferred.
Minimum one to two (1-2) years of experience in a customer service, call center, or patient-facing administrative healthcare role.
Prior experience in a Medicare Advantage, managed care, or medical office setting preferred.
Experience with CRM or case-management software preferred.

Nice To Haves

Bilingual proficiency (Spanish or another language relevant to the patient population) a plus.
Associate's degree or relevant certification preferred.
Prior experience in a Medicare Advantage, managed care, or medical office setting preferred.
Experience with CRM or case-management software preferred.

Responsibilities

Fields inbound and outbound tickets across the three in-scope workstreams (Non-CPL (Coordinated Provider List)/Out-of-Network Requests, Care Plan Non-Adherence, and Voluntary PCP Switches) via the centralized, 100%-recorded intake queue, sourced from Careline & Field-Initiated Tickets, Patient-Initiated Appeals for Clinical Review, and Non-CPL/Out-of-House Requests channels.
For Non-CPL/Out-of-Network Requests: engages patients who want to use a provider outside the CPL, explains available in-network/CPL-coordinated options, and encourages use of those options through positive, informative conversation — without denying, authorizing, or influencing any coverage or network-exception determination, which remains the responsibility of formal Utilization Management.
For Care Plan Non-Adherence: conducts first-touch outreach to patients flagged as unable or unwilling to follow a recommended care plan, using supportive, empathetic communication to understand and address straightforward barriers; escalates any case involving a genuine clinical barrier, safety concern, or need for informed-refusal documentation to a Tier 2 RN/Licensed Social Worker rather than attempting to resolve it directly.
For Voluntary PCP Switches: processes patient requests to change their assigned PCP promptly, completely, and without applying any retention pressure or persuasion; ensures attribution changes, record transfers, and required documentation are initiated accurately and within required timeframes.
Documents every case in the centralized case-management system to the standard required for CMS delegation-oversight audits, including outreach attempts, call content, outcome, and any escalation — documentation quality is treated as a core job function, not an afterthought.
Recognizes when a ticket falls outside Tier 1 scope or outside the three in-scope workstreams entirely (e.g., unreachable-patient cases, complex clinical needs, roster/eligibility hygiene, or a disruptive-behavior report) and routes it to the correct owning team rather than attempting to resolve it.
Maintains a consistently professional, composed, and empathetic tone on 100% recorded and monitored calls, understanding that call quality is subject to ongoing QA review.
Meets individual productivity and quality standards for call volume, average handle time, and documentation completeness as defined by the Manager, Patient Navigation.
Participates in ongoing training on CMS compliance topics relevant to the role (non-discrimination, member-choice protections, confidentiality) and on script/process updates.
Performs other duties as assigned and modified at manager's discretion.