PRN Care Navigator

About the role

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.

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.

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
• 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.

Qualifications

• 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