OB Patient Navigator - JHP

Job Details

The Patient Navigator act as a primary point of contact for Health Partners Plan (HPP) patients and family members accessing perinatal healthcare services at a designated provider point of care location. The Patient Navigator is responsible for providing personalized support and guiding health plan members throughout their healthcare experience. This position supports the Enhanced Member Supports Case Management programs and works under general supervision, conducting field based and telephonic engagement and outreach to members. This includes providing education on provider treatment recommendations, health plan benefits and follow-up support, following all departmental protocols.

Job Description

Essential Functions: 

• Responsible for targeted engagement of health plan members includes verifying member eligibility using appropriate systems and assisting in the greeting and check in process at the point of provider’s care location for health plan members.
• Educate members regarding health plan benefits and community and resources as well as other applicable programs if applicable. 
• Inform members about applicable Enhanced Member Supports Unit (EMSU)/Clinical Programs.
• Open or build new cases in the care management system and conduct initial assessments to understand patient needs and challenges, developing tailored navigation plans and route to the health plan for ongoing care coordination as indicated by criteria/protocol. 
• Coordinate appointments, referrals, prescription refills, lab work, procedures and follow-up communications to ensure continuity of care. This may include calling hospitals, provider offices, pharmacies, and home care agencies.
• Educate patients about their health conditions, treatment options, and available resources, empowering them to make informed decisions.
• Collaborate with healthcare providers, specialists, and community resources to advocate for patients and facilitate access to care.
• Monitor low risk patient progress and outcomes, adjusting navigation strategies as necessary to address evolving needs.
• Connecting high risk members to care coordinator supporting the Baby Partners program.
• Identify and address member reported potential barriers to care that may include lack of food, heat, transportation, and other services. 
• Interpret, translate, or provide cultural mediation related to health services or information for members. 
• Utilize language services as needed for the member following the process outlined by department for members with limited English proficiency.  
• Assist patients in resolving insurance and billing issues.
• Helping patients understand and complete necessary paperwork.
• Act as a liaison between members and healthcare providers.
• Ensure patient confidentiality and data privacy.
• Assist department at targeted community events. 
• Assist department in HEDIS improvement activities following the direction of the Clinical Team Lead or Manager.  
• Actively participate in department activities and offer recommendations to processes to ensure success of the department. 
• Document all EMSU support/outreach activity in provided software system. 
• Escalate issues that are beyond the scope of this job description following the department protocols. 
• Other duties as assigned. 

Supervisory Responsibility:  

This position does not have supervisory responsibility, nor does it provide case management services. This position reports to staff who are Certified Case Managers (CCM). 

Work Environment: 

This position is office based.  

  

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Physical Demands 

While performing the duties of this job, the employee is regularly required to talk and hear.  

Travel 

Travel may be required when asked to attend training and community/provider or member activities.  

Required Education and Experience: 

Education:   

• High School Graduate or GED 
• Associate degree or bachelor’s degree preferred. 
• 3+ years of experience in healthcare or a related field, with a focus on patient advocacy or navigation.
• Minimum of one-year steady job experience in health care preferred. 

Skills and Abilities: 

• Bilingual, with Spanish speaking required, when applicable based on provider’s population. 
• Strong phone skills required. 
• Strong interpersonal communication skills required. 
• Knowledge of medical terminology and medical