Patient Navigator

About the role

The Patient Navigator position at NATIVE HEALTH is dedicated to improving access to care and enhancing patient understanding of health services. This role supports the mission of providing accessible, holistic patient-centered care and empowering the community to achieve the highest quality health and well-being.

Responsibilities

• Works collaboratively with the Clinical Case Manager and Integrated Behavioral Health Consultant to bring support services to the client.
• Health navigation and accompaniment services to medical requirements.
• Follow-up with patients regarding appointment reminders and counseling appointments.
• Assistance with transition of care for hospitalization and follow-up with PCP.
• Conducts weekly/regular calls to check-in, for encouragement, appointment reminders, and to reschedule missed appointments.
• Congratulates patients on successful completion of treatment plans.
• Coordinates and assists with transportation.
• Works with the Integrated Behavioral Health Consultant to provide referrals and follow-up to Behavioral Health providers.
• 90% of patients referred to internal or external services are successfully connected within 14 days.
• Document navigation activities in the EHR for 100% of patient encounters within 72 hours of the initial encounter.
• Conduct over the phone outreach to schedule appointments for clinical measure gap closer.
• Makes contact with patients who have been admitted to ER and released from inpatient care.
• Follows up with patients who conduct the after-hours provider coverage.
• Conduct comprehensive patient needs assessments, including social determinants of health (SDOH), and connects patients to appropriate community resources.
• Conducts and documents the PREPARE assessment to assess SDOH needs.
• Provides resources relating to the patient's needs.
• Achieves successful linkage to community resources (e.g., housing, food, transportation) for at least 80% of patients with identified needs within 30 days.
• Maintains a resource guide for all PREPARE measures assessed.
• Works collaboratively with healthcare providers, pharmacies, insurance representatives, and social service agencies to ensure coordinated care.
• Links patients to onsite primary care, behavioral health, recovery programs, pharmacy services, and supportive housing services.
• Participates in 95% of scheduled care team meetings and provides updates on patient progress.
• Assists Medical Assistants with request for durable medical equipment (DME) and prior authorization requests.
• Achieves a patient satisfaction rate of at least 85% on navigation-related support (measured through patient survey).

Qualifications

• Must have a high school diploma or equivalent; an associate's degree, bachelor's degree or higher is preferable.
• Preferred certified phlebotomist or willing to become certified.
• Must have experience navigating and working in a clinical setting.
• Must be familiar with working in a team environment.
• Must be willing to work in community setting at outreach events.
• Bilingual Spanish speaker preferred but not required.
• Flexible work hours may be required during evenings and weekends.
• Must possess a valid and unrestricted Arizona driver’s license (within 30 days of hire if applicant is from out-of-state) with no DUI/DWI or reckless driving convictions in the last five years.
• No more than two at-fault accidents in the last three years.
• Must maintain a valid Arizona driver’s license during employment.
• Must be insurable under NATIVE HEALTH’s liability auto policy.
• Must pass a criminal background check and obtain a Class I Fingerprint Clearance Card within the initial ninety (90) calendar days of employment and retain a valid card while employed with NATIVE HEALTH.
• Must pass substance abuse testing upon employment and submit to random testing during employment.
• Must provide an updated immunization (IZ) record at the time of employment.
• Must have a current (within 12 months) Tuberculosis (TB) skin report upon employment and provide an annual update.
• Must obtain Basic Life Support (BLS) certification within (90) calendar days of employment and maintain certification during employment.