Job Description

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The Patient Navigator is a member of a multi-disciplinary team and will assume responsibility and accountability for the management of patients through the healthcare system.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s degree in Healthcare Management, Public Health, or other related field OR;
2. Associate’s degree in Healthcare Management, Public Health or other related field AND two (2) years of experience directly related to the duties and responsibilities specified. OR;
3. High school diploma or equivalent AND (4) years of experience directly related to the duties and responsibilities specified.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s degree in Healthcare Management or Public Health.

EXPERIENCE:

1. Three (3) years’ experience in the healthcare field. One (1) year of experience in statistical data analysis.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Establishes close relationships with and serves as primary point of contact for patients.
2. Strategizes to help find payor population based on regional payer mix by collecting and analyzing market data. Responsible for verifying insurance benefits and ensuring coverage for obesity treatment for patients.
3. Maintain a working knowledge of insurance payors pre-certification requirements for medications, diagnostic testing, surgery, referrals, etc. Proactively review policies for changes to prevent delays in certification where applicable.
4. Educates providers and staff on payor regulations in order to prevent denials.
5. Removes barriers to care by identifying resources for patients and helping them navigate through healthcare services.
6. Works with different service lines to assure coordination of appointments if applicable.
7. Schedules patient appointments and adjusts as needed. This includes coordinating appointments with laboratory or diagnostic testing, ensuring adherence to appointments, reminder calls, and managing the patient wait-list.
8. Will be aware if one of their assigned patients is admitted and will round on them daily / assists with scheduling discharge appointments.
9. Assists with getting prescriptions filled. Assesses cost, availability etc.
10. Documents patient information and obtains outside records, as needed.
11. Engages family and/or community resources to meet the identified emotional, social, and financial needs of the patient.
12. Collaborates with available social services for appropriate resource and financial management which may include, but is not limited to, financial assistance coordination and referrals, entitlement program coordination and referrals, patient benefit coordination, assessment for appropriate usage of healthcare resources, and clinical cost efficiency.
13. Other department specific duties may be assigned.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to sit for extended periods of time.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office/clinical environment.

SKILLS AND ABILITIES:

1. Possesses excellent interpersonal communication and negotiations skills in interactions with patients, families, providers, and healthcare team colleagues.
2. Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open-minded, and adaptable to change.
3. Proficient in Microsoft Office.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

415 SYSTEM Population Health Management