Job Description

Job Summary

The Patient Navigator – Non-RN is responsible for coordinating care transitions, improving patient outcomes, and supporting appropriate in-network resource utilization across the post-acute continuum. This role collaborates with clinical and administrative teams, post-acute providers, and community resources to reduce avoidable readmissions and ensure continuity of care. The Patient Navigator uses tracking tools and performance data to influence utilization trends, strengthen provider networks, and support overall quality and cost goals.

Essential Functions

• Supports the development and maintenance of a preferred post-acute care (PAC) provider network in accordance with facility and ACO guidelines.
• Reviews post-acute referral processes and identifies opportunities for improved coordination, efficiency, and patient experience.
• Utilizes care coordination software and reporting tools to track patient transitions, monitor utilization patterns, and identify potential readmission risks.
• Provides education to referring physicians and hospital staff regarding post-acute care options, network alignment, and preferred provider protocols.
• Monitors and analyzes PAC utilization metrics, including average length of stay (ALOS), RUG levels, emergency department visits, and transfers.
• Reviews readmission rates and retention metrics, partnering with PAC providers to support quality improvement initiatives.
• Documents all patient and provider interactions, referrals, and coordination efforts in accordance with facility documentation standards.
• Prepares and distributes utilization and readmission performance reports for PAC partners and ACO leadership.
• Collaborates with facility and system leadership to improve in-network utilization and ensure optimal patient navigation across the accountable care continuum.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• Associate Degree in healthcare, social services, or a related field preferred
• 3-5 years of experience in care coordination, case management support, or healthcare navigation required
• 1-2 years of experience working with post-acute care providers or accountable care organizations (ACO) preferred

Knowledge, Skills and Abilities

• Understanding of post-acute care services and transitions of care best practices.
• Familiarity with healthcare utilization metrics, readmission risk factors, and network management strategies.
• Strong interpersonal and communication skills, with the ability to engage with patients, families, providers, and interdisciplinary teams.
• Proficiency with electronic health records, care tracking systems, and reporting tools.
• Ability to analyze data and prepare performance summaries for operational decision-making.
• Knowledge of community resources and social support services.
• Strong organizational skills with the ability to manage multiple tasks and priorities.
• Commitment to quality improvement, patient-centered care, and cost-effective service delivery.