Primary Care Patient Navigator

Southwest Healthcare

2d • Onsite

About The Position

Southwest Care Center employees can answer yes to these 3 questions: 1. Do you want to make a difference? 2. Do you believe everyone is entitled to quality healthcare? 3. Do you desire to serve the underserved in your community? For over 25 years, Southwest Care Center has been providing exceptional healthcare to the communities of Santa Fe and Albuquerque, NM. We are a non-profit, FQHC-LAL providing medical, behavioral health, case management, community outreach, diabetes education, and pharmacy services. We are proud to offer gender equity medicine, syringe exchange, and HIV/Hep C treatment, testing and other services within our communities. Southwest Care Center is currently seeking an experienced full-time Patient Navigator. This position supports our Galisteo Clinic in Santa Fe, NM. Position Details: Under the direction of the Clinic Manager, the Patient Navigator serves as a coordinator and liaison between patients with gaps in care, including healthcare and social determinants of health services within the community. The role involves evaluating patients' health literacy and social service needs, identifying and referring patients to support social service programs, providing case management, and patient education to remove barriers to care. This position provides care for patients who do not easily fit within the standard medical model and works closely with medical providers, primary care teams, and other agencies to improve patient outcomes and care for socially vulnerable populations. Position responsibilities include but not limited to: Manage a caseload of primary care patients by performing initial and regular reassessment of patient needs and developing, implementing, and updating a plan of care to address identified needs. Resolve patient barriers to accessing health care services by linking with transportation and translation services, appointment scheduling, communication with medical and behavioral health care teams, etc. Ensure financial support to facilitate patient access to services including identify and address gaps in insurance status, process sliding scale applications, process applications to linkage to medication programs, and connect patients to available community resources to assist in bridging financial barriers to care. Provide walk in support to patient’s family members, and community members with a focus on quickly decreasing patient obstacles to care. Provide patient education, guidance, and emotional support to help patient meet identified care goals. Review expectations of engagement in care with patients, including completing conduct agreements for behavior and appointment attendance. Develop trust and maintain positive relationships with patients, community members, social service organizations and internal SCC teams. Maintain comprehensive patient records in SCC systems and the patient Electronic Medical Record, ensuring compliance to all confidentiality and HIPAA regulations. Actively participate in multi-disciplinary meetings and daily clinic care team huddles to identify patients who could benefit from case management services, discuss patient needs as they arise, and ensure coordination of medical, behavioral, and case management services to SCC patients. Utilize respectful and professional communication to contribute to a supportive and inclusive environment. Assist in the planning and execution of SCC community events, including support to regular Community Advisory Board meetings. Network with other community groups and social service organizations, creating opportunities for joint partnerships. Maintain events, training, and meeting details in the team shared calendar. Perform other job duties as assigned.

Requirements

• Minimum 1 years of experience in a primary care setting with 3+ years preferred.
• High school diploma or equivalent, bachelor’s degree preferred.
• Basic Life Support Certification, Community Health Worker (CHW) certification required or obtained within 12 months of employment.

Nice To Haves

• Medical Assistant experience is highly desirable.

Responsibilities

• Manage a caseload of primary care patients by performing initial and regular reassessment of patient needs and developing, implementing, and updating a plan of care to address identified needs.
• Resolve patient barriers to accessing health care services by linking with transportation and translation services, appointment scheduling, communication with medical and behavioral health care teams, etc.
• Ensure financial support to facilitate patient access to services including identify and address gaps in insurance status, process sliding scale applications, process applications to linkage to medication programs, and connect patients to available community resources to assist in bridging financial barriers to care.
• Provide walk in support to patient’s family members, and community members with a focus on quickly decreasing patient obstacles to care.
• Provide patient education, guidance, and emotional support to help patient meet identified care goals.
• Review expectations of engagement in care with patients, including completing conduct agreements for behavior and appointment attendance.
• Develop trust and maintain positive relationships with patients, community members, social service organizations and internal SCC teams.
• Maintain comprehensive patient records in SCC systems and the patient Electronic Medical Record, ensuring compliance to all confidentiality and HIPAA regulations.
• Actively participate in multi-disciplinary meetings and daily clinic care team huddles to identify patients who could benefit from case management services, discuss patient needs as they arise, and ensure coordination of medical, behavioral, and case management services to SCC patients.
• Utilize respectful and professional communication to contribute to a supportive and inclusive environment.
• Assist in the planning and execution of SCC community events, including support to regular Community Advisory Board meetings.
• Network with other community groups and social service organizations, creating opportunities for joint partnerships.
• Maintain events, training, and meeting details in the team shared calendar.
• Perform other job duties as assigned.

Benefits

• Great work/life balance with generous time off plans.
• Full benefits package includes medical, dental, vision, 401k with substantial employer contribution, paid time off, professional development programs, and 340B prescription access.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED