Job Description

Key Responsibilities

Quality & Clinical Compliance

• Complete OCH screenings in accordance with organizational standards (>90% completion).

• Support Advance Care Planning (ACP) discussions and documentation (>85% completion).

• Manage medication refill requests efficiently, maintaining low monthly volume.

• Identify, document, and report OCH adverse events accurately and timely.

Operations & Care Management

• Support completion of APCM care plans aligned with patient needs.

• Coordinate patient scheduling to ensure timely follow-ups and visits.

• Complete patient consenting processes accurately.

• Support enrollment and ongoing management of Behavioral Health Integration (BHI) services.

• Assist clinicians with visit and note preparation to support efficient, high-quality documentation.

Administrative Excellence

• Maintain accurate insurance information and patient facesheets.

• Ensure care plan flags and documentation are complete and up to date.

• Process patient discharges according to defined workflows.

• Support audits and administrative reviews with accurate, timely documentation.

Relationship Management

• Build and maintain strong relationships with partner facilities.

• Conduct regular pulse checks with facilities to assess needs and satisfaction.

• Participate in QAPI meetings and quality improvement initiatives.

• Complete required facility visits and maintain consistent engagement.

Why This Role Matters

• Improves clinician efficiency by assisting with note preparation and administrative workflows

• Strengthens facility satisfaction through consistent on-site presence and high-touch customer service

• Protects revenue and compliance by ensuring accurate documentation, consenting, and care coordination

• Supports quality outcomes tied to organizational performance metrics

Career Path & Growth Opportunity

This role is designed as a growth opportunity for high-performing Clinical Support Specialists. It offers increased compensation, expanded responsibility, and exposure to clinical operations leadership. The Care Navigator position serves as a stepping stone for broader advancement across the organization, including future opportunities in care management, clinical operations, and leadership roles.

Performance Metrics

Performance in this role is evaluated using a balanced scorecard across: - Quality outcomes (screenings, ACP, adverse event reporting) - Operational effectiveness (care plans, scheduling, enrollment) - Administrative accuracy (documentation, audits, discharges) - Relationship health (facility engagement, attendance, communication)

Required Skills & Qualifications

• High school diploma or equivalent (required)

• 2 years related experience as an Administrative Assistant, Clinical Support Specialist, or Certified/Registered Medical assistant required. Experience in long-term care or care coordination settings preferred

• Strong attention to detail and documentation accuracy

• Ability to manage multiple workflows and priorities

• Excellent verbal and written communication skills with the ability to work effectively in team-based environments

• Proficiency with Outlook and related collaboration tools (email, calendar management, team communication)

• Ability to provide high-quality customer service to both facility partners and internal clinical teams

• Comfort working with quality metrics and performance goals

Preferred Qualifications

• Experience in value-based care, APCM, BHI, or care coordination programs

• Familiarity with EHR systems and healthcare compliance standards

Work Environment

• Primarily in-person role within long-term care facilities

• Remote or hybrid work may apply for physician assignments and coordination across multiple facilities

• Dynamic, fast-paced healthcare environment requiring flexibility and strong organizational skills

• Regular collaboration with clinicians, facility leadership, and internal operations teams