Per Diem Care Navigator

Crossover Health•West, WV

1d•Remote

About The Position

For patients who need care outside of Crossover’s Onsite and Near site clinics, we are actively curating a network of medical specialists in the community who will partner with us to coordinate and deliver excellent care. The focus is on demonstrated high-quality care, patient experience, practice efficiency, cost effectiveness, and a service level consistent with Crossover Health standards. This position will help to manage, update and curate this network in addition to taking over full logistical and workflow ownership of the referral process. This will include capturing all incoming clinic requests for referrals, managing the scheduling and appointment creation for all referrals, communications between patient, specialist, and Crossover, and documentation in the appropriate tools.

Requirements

At least 3 years of applicable experience (experience in a Primary Care setting preferred)
High school diploma/GED required
Proficient working with Google spreadsheets and/or excel, database management and data tracking

Nice To Haves

Bachelor’s Degree or relative medical experience
Experience processing referrals for a medical group
Creative and flexible and effectively manages obstacles
Excellent follow-through and have strong task execution skills
Able to handle ambiguity when problem solving
Thrive in a fast-paced and rapidly changing environment
Ability to work in multiple technology platforms simultaneously, using clinical judgment and critical thinking in accessing and documenting information that pertains to each patient’s referral process
Organization and accountability within a fluid and constantly changing environment
Strong communication, customer service and people skills; the ability to connect with all stakeholders (patients, doctors, nursing staff, clinic staff, technicians)
Excellent problem solving and problem preempting skills
Willingness and drive to go the distance to help
Work with a team to create new and improved workflows that build upon our new centralized referral management product

Responsibilities

Daily processing of referrals to secondary care, outside of Crossover Health (specialists, imaging, community resources, employer benefits).
Maintain high quality specialist, community service, and employer benefit directories.
Maintain ongoing communication, tracking, and appropriate documentation on referrals to ensure continuity of care. This tracking may use an IT database.
Ensure that referrals are addressed in a timely manner.
Assist with training relevant stakeholders (MDs and CNs) on the external referral process.
Assist with prior authorizations as needed.
Be the single point of contact between specialists, the clinic physicians, and the patients when care is needed outside of a Crossover Health clinic, and provide updates as appropriate to the clinical team to ensure visibility into active referrals.
Use clinical judgment and critical thinking to discern and refine the correct provider type and stratify the urgency of the referral, in consultation with clinical team members when necessary.
Generate a complete referral packet and ensure timely submission to the specialist of the appropriate clinical documents to support the request for the referral (pertinent clinical notes, historical medical records, imaging reports, lab results).
Ensure the arrival of the packet at the specialist office and a timely patient appointment.
Work within the parameters of the patient insurance benefits and consult with benefit specialists as needed for the most high quality and cost effective care.
Troubleshoot downstream complications or unexpected circumstances so that patient needs are placed first and gaps in care are averted.
Interface regularly in a professional and collegial way with primary care MD’s and RN’s and clinic Hosts.
Assist in the development of technology and service innovations to ensure a closed loop system of communication and coordination with our Crossover providers and network specialists.
Performs other duties as assigned.