Care Navigator

Job 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.
• Afford assistance 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.
• Afford assistance 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.

Required Qualifications

• 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
• Preferred qualifications include a Bachelor’s Degree or relative medical experience, experience processing referrals for a medical group, creative and flexible, 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, able 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

Physical Job Requirements

• May require standing, walking and sitting for extended amounts of time.
• Occasionally lift and carry items weighing up to 50 lbs.
• Manual and finger dexterity and hand-eye coordination.
• Includes full range of body motion.
• Requires corrected vision, hearing and speech within normal ranges.
• Must be able to effectively communicate with patients and team members.

Pay and Benefits

The base pay range for this position is $23.53 to $31 per hour. Pay range may vary depending on work location, applicable knowledge, skills, and experience.

This position will be eligible for a comprehensive benefits package that includes Medical Insurance, Dental Insurance, Vision Insurance, Short- and Long-Term Disability, Life Insurance, Paid Time Off and 401K.