Outpatient Navigator

Purpose Statement

The Outpatient Navigator supports continuity of care by guiding eligible patients transitioning from inpatient or residential behavioral health treatment, or the community into Partial Hospitalization (PHP), Intensive Outpatient Programming (IOP), or other community-based services. This role ensures timely, informed referrals; facilitates coordination among inpatient and outpatient departments; and provides education and support to patients and families regarding post-discharge services. The Outpatient Navigator is also responsible for coordinating and obtaining pre-authorizations for new patients and securing continued authorizations for ongoing therapy services, working collaboratively with patients, clinical staff, and payors to determine appropriate length of treatment based on clinical need and progress. This includes monitoring authorization timelines, proactively initiating reviews for continued stay, and ensuring documentation supports medical necessity.

Essential Functions

• Own the full step-down process—from patient identification to program admission
• Meet every eligible inpatient and review open direct admission inquiries to facilitate referrals to outpatient
• Education patients and families on the value of continued care post-discharge and highlights of the hospital’s program (specialized tracks, support to address barriers to access such as transportation, etc.)
• Maintain multiple in-person check-ins during patient’s inpatient stay, including 1:1 discussions, facilitation of inpatient transitions/discharge groups, and participation in treatment team
• Support patients with outpatient orientation/program introduction, including completion of required admissions documentation and consent forms, and introductions to PHP/IOP leaders and therapists
• Partner with other hospital departments to facilitate step-downs, including: Clinical services to confirm clinical appropriateness for outpatient and include outpatient in treatment plans, Business office (BO) for benefits verification and copay clarifications, Utilization Review/Management (UM) to secure necessary authorizations. Support with ongoing UM, as needed, including, but not limited to pre-certifications, renewal authorizations, denial appeals, and tracking days remaining, Business development and marketing for support to convey outpatient value proposition and key messages for patient engagement, Outpatient Services to ensure capacity, program compatibility, and mutual awareness of discharge dates
• Participate in daily flash meetings to review emerging step-down candidates, rationale for discharges not stepped down, and report out on day one PHP/IOP attendance for prior day’s step-downs

Performance Monitoring and Continuous Improvement

• Track step-down admissions and conversion rate and trends over time
• Identify barriers/opportunities to further enhance patient engagement and reduce readmissions
• Report weekly progress to facility CEO, COO, and Director of Outpatient Services

Education/Experience/Skill Requirements

• Required: High school diploma or equivalent required. Bachelor’s degree in social services-related field strongly preferred.
• Preferred: Licensed or license-eligible clinician (e.g., LCSW, LPC, LMHC, LMFT)
• Peer support specialist certification
• Experience with PHP and IOP levels of care, discharge planning, and/or utilization review