Connected Care Patient Navigator

Job Details

This role is crucial for delivering exceptional patient service and conducting Health Related Social Needs (HRSN) assessments in various clinical and community settings. It involves performing screenings for HRSN as well as other critical health-related screening (e.g., assessing for missed/delayed cancer screenings), documenting results, and validating patient information to ensure maximum service benefits. The position also includes implementing optimal referrals, educating patients on resources, and providing follow-up support to ensure receipt of services. Regular communication with Connected Care Services staff and collaboration with the care team are essential to maintain organized records and provide culturally humble interactions.

Job Description

Essential Functions

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.

Patient Experience and Service Excellence

• Deliver exceptional service and resolve every transaction with the highest level of professionalism, ensuring a patient experience that reflects our unwavering commitment to efficient and effective care connections. Demonstrate dedication to service excellence and consistent follow-through.

Screening Responsibilities

• Conduct Health Related Social Needs (HRSN) assessments onsite in various clinical and community settings for patients and community members.
• Engage with patients who present to clinical care settings to 1) determine whether they have a missed/delayed cancer screening and 2) educate patients who do have a missed/delayed cancer screenings about the importance of receiving screening as well as pathways to pursue future screening. 
• Accurately document screening results and adhere to workflows to communicate positive screenings to relevant staff.
• Validate demographics and other essential registration fields (e.g., PCP, telephone number, address, email) by obtaining and/or confirming patient information to maximize service benefits.
• Support patient’s digital literacy by training them in how to use tools such as MyChart.

Referral Management and Education

• Implement optimal HRSN referrals for individuals based on screening results, with support from referral specialists.
• Educate patients on available resources, guide them on independent access (e.g., setting up rides), and assist in completing necessary paperwork for program approval (e.g., insurance applications).
• Provide targeted education to patients who are identified to have a missed/delayed cancer screening, including relevant factors about importance of screening as well as supporting connection in for patients as relevant to future screenings.
• Conduct follow-up assessments and provide ongoing support to ensure individuals receive services related to referrals (loop closure). For many patients, this will include troubleshooting cases in which resources were not received.
• Schedule medical appointments for patients as needed.

General Duties

• Maintain regular communication with Connected Care Services staff.
• Collaborate with the care team regarding HRSN results, interventions, and update the team on referral outcomes and patient satisfaction with resources.
• Ensure organized and secure record-keeping of screenings and timely data entry.
• Apply cultural humility in interactions with clients and staff.
• Operate with a high level of independence, as staff will often be working without other team members onsite across Enterprise locations
• In many locations, this will be a new workflow that requires ongoing attention to achieve clinical staff buy in and partnership, that this staff member will play a critical role in as the person working on site daily

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Thomas Jefferson University

Primary Location Address

1015 Walnut Street, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research.