Care Team Navigator

Duties and Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ensure the functions and activities of this department and embrace the philosophy, mission, and values and Communicate with Heart service model supported by the Board of Directors of Pueblo Community Health Center, Inc. Adhere to the guidelines and procedures of Pueblo Community Health Center, Inc. Facilitate patient access to Pueblo Community Health Center, staff and resources at Pueblo Community Health Center. Receives and reviews all referral/diagnostic requests/orders from care team to initiate order tracking protocol. Obtains necessary prior authorizations for specialty care from insurance providers. Maintains ongoing tracking and appropriate EHR documentation to promote team awareness for all in-house and community service providers. Document all patient contacts and interaction in the medical record. Assure records from specialty care and hospitals are received and incorporated into EHR. Provide timely communication, inquiry, follow up and integration of information into the medical record. Schedule follow-up appointments at PCHC within established protocol on emergency room visits. Facilitate post-discharge services within established protocol on inpatient transitions of care. Collaborate with Outreach and Enrollment to have patients new to PCHC that are scheduled for hospital follow-up appointments enrolled prior to their appointment. Process home health referrals and follow-up with patients and providers within established home health protocol. Process outpatient physical therapy/occupational therapy referrals and follow-up with patients and providers within established outpatient therapy protocol. Employ active listening and remain solutions-oriented in interactions with patients, families, and members of the health care team. Display non-judgmental acceptance, maintain confidentiality, and establish positive rapport and working relationships with patients/ family/ visitors/ staff/ community. Provide patient, family and community stakeholders’ information, resources and authorizations to facilitate continuity of care. Demonstrate decision-making, critical thinking, and problem-solving skills. Work collaboratively with all care team members for the benefit of the patient. Works with patients to assess/address barriers to keeping specialist appointments. Develop and maintain relationships with medical and behavioral health providers of Pueblo Community Health Center and community stakeholders. Serve as a contact person, advocate and informational resource for the patients, families, PCHC providers and community stakeholders. Perform other related duties as assigned for the benefit of the department, PCHC, and the patient. The above duties are not all inclusive and are not intended to limit or define the duties that may be assigned.

Closing Date

Open until filled. Pueblo Community Health Center is a tobacco-free workplace. EOE Apply online at Pueblo Community Health Center Qualifications