JOB SUMMARY:
The Patient Navigator actively participates in care management and coordination activities for patients of the primary care practice. This includes developing and monitoring care coordination workflows, supporting clinical teams, and using patient care registries—both internal and payer-supplied—to track progress. The Patient Navigator utilizes applicable Third-Party Payer portals to transcribe and submit patient data as documented in Franklin’s EHR system. All activities are reported using a standardized process. Strong organizational skills, exceptional customer service, and proficiency in Microsoft Excel, Word, and Office Suite are essential to succeed in this role. The Patient Navigator is expected to consistently behave professionally and provide high-level support to both the patient panel and care teams.
ESSENTIAL FUNCTIONS:
Coordinate and schedule patients for Annual Wellness Exams and closure of clinical care gaps, working directly with Medicare Advantage and other Third-Party Payers.
Facilitate Franklin’s participation in value-based incentive programs to support quality outcomes and revenue growth.
Utilize patient registries and payer-supplied lists to track patients needing outreach or gap closures.
Transcribe and submit patient data from the EHR into applicable payer portals to ensure quality measures are captured and documented appropriately.
Understand and apply HEDIS measures in daily tasks to ensure quality compliance.
Accurately document patient interactions and actions taken in the EHR.
Attend all required quality meetings and training sessions hosted by payers and the organization.
Maintain organized records and support performance tracking for clinical quality metrics.
Communicate effectively with patients, providers, and payer representatives to ensure smooth coordination.
Provide exceptional customer service during all patient and payer interactions.
Collaborate with primary care teams to support clinical workflows and care delivery.
Involve patients in activities to improve their health (patient engagement).
Serve as a resource to provider care teams to reach quality goals.
Participate in professional development activities to stay abreast of Medicare AWV and quality measure requirements.
JOB DESCRIPTION
CARE COORDINATOR
The preceding examples are representative of the assignments performed by this position and are not intended to be all-inclusive.
SKILLS:
- Knowledge of medical practice and care of patients
- Skills in developing and maintaining clinical quality assurance
- Ability to use good judgment and critical thinking skills; ability to identify and resolve problems
- Ability to interpret, adapt, and apply guidelines and protocols
- Ability to maintain medical records
- Ability to establish and maintain effective working relationships with patients, families, medical staff, and co-workers
- Ability to work independently, while collaborating with other team members
- Ability to self-motivate, prioritize, and be willing to invest in a change process to improve efficiencies
- Excellent written, verbal and listening communications skills
- Basic computer skills – data entry, retrieval and report generation
- Ability to work with a diverse patients/family population
CUSTOMER SATISFACTION REQUIREMENTS: Must provide the very best customer satisfaction to staff, visitors, guests, and patients at all time in a professional and courteous manner.
PERFORMANCE STANDARDS: The Deputy Director/Director will evaluate Performance annually wherein a satisfactory overall rating is considered as a minimum acceptable level of performance.
HEALTH AND SAFETY REQUIREMENTS: The health and safety requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Must adhere to safety regulations, personnel policies and procedures.
Safety and Hazard Communication training update is required annually.
Knowledgeable of OSHA and CLIA requirements to assure compliance.
Maintain yearly health maintenance records by obtaining TB skin testing and completion of the hepatitis series.
PRIVACY RULE COMPLIANCE REQUIREMENTS:
Adheres to Health Insurance Portability and Accountability Act (HIPAA Privacy Rule) policies and procedures.
Must successfully complete Privacy Rule compliance training annually or as revisions are made to the policies and procedures.
Must comply with Privacy Rule guidelines by learning to protect FPHC patient’s medical privacy.
Must comply with Privacy Rule guidelines by appropriately maintaining our patient information in compliance with national standards.
Must comply with Privacy Rule guidelines by providing appropriate security of FPHC patient records.
QUALIFICATIONS:
EDUCATION AND EXPERIENCE:
High school diploma or equivalent required
Experience in healthcare coordination, quality programs, or administrative support roles preferred.
Strong organizational and time-management skills.
Exceptional customer service and communication abilities.
Ability to work both independently and collaboratively across departments and payer networks.
High attention to detail, accuracy in documentation, and ability to manage multiple tasks.
KNOWLEDGE, SKILLS AND ABILITIES: Demonstrates administrative and organizational skills. Assumes responsibility for own continued personal and professional growth. Demonstrates appropriate manner, conduct, grooming and sound judgment. Demonstrates ability to work cooperatively and communicate effectively. Good health and consistent attendance.
PHYSICAL/MENTAL DEMANDS:
Must be able to express ideas clearly and concisely; and exercise balanced judgment in evaluating situations and making decisions.
Work requires sitting, standing for long periods of time
PROTECTED HEALTH INFORMATION (PHI) ACCESS: RESTRICTED- For purposes of HIPAA Compliance, there are four workforce categories, which define the level of access to PHI that is granted to the incumbent. This position is classified as PRIMARY PROVIDERS and therefore is granted RESTRICTED access- to be defined according to the purpose for which use or disclosure is intended. Use and disclosure must be in accordance with applicable privacy policies and procedures.
