Patient Support Care Navigator

Brown Medicine•Baltimore, MD

1d•$21 - $35•Onsite

About The Position

The Patient Support Care Navigator supports the Care Management department in caring for rising-risk and high-risk patients and helps obtain information about patients’ medical and social needs. The role assists patients in navigating the healthcare system and works closely with care teams to identify patient needs and community resources that can help patients achieve optimal health outcomes, transition safely, and reduce unnecessary hospital utilization. Brown University Health employees are expected to role model the organization’s values of Compassion, Accountability, Respect, and Excellence. Employees are also expected to demonstrate the core Success Factors: Instill Trust and Value Differences; Patient and Community Focus and Collaborate.

Requirements

High school diploma or equivalent.
Medical Assistant Certification or equivalent clinical training.
At least 1 year of experience directly related to the duties and responsibilities of the position.
In-depth understanding of medical insurances and benefits.

Nice To Haves

Associate degree preferred.

Responsibilities

Screen patient census using provided criteria to determine whether patients should be categorized as high risk.
Manage the high-risk patient census and assess whether intervention from the Nurse Care Manager (NCM) or another disease management or population health program is needed.
Assess patients for basic needs and intervene when appropriate, referring patients with greater needs to the NCM.
Work closely with the NCM to help patients reach their goals, maintain safety, and improve their health.
Maintain awareness and understanding of community and BHMGPC resources and teams to offer patients.
Hand off communication to the NCM or another BHMGPC program when necessary.
Work with the NCM to develop and update patient care plans and attend care conferences and huddles as needed.
Perform telephonic and remote patient outreach and document all outreach and interventions in the electronic medical record (EMR).
Facilitate and reinforce patient self-management under the direction of the NCM, and encourage patients to stay current with labs, PCP and specialist visits, and their care plan.
Evaluate patient safety.
Ensure documentation is collected from patient specialist visits.
Provide resources and disease management education to patients.
Lightly discuss MOLST and durable power of attorney forms with patients.
Understand durable medical equipment (DME) needs and referrals.
Assist patients with transportation needs.
Perform other job-related duties as assigned.