HCBA Patient Care Navigator
Description
The Position: Reporting to the HCBA RN Case Manager Supervisor, performs as HCBA department generalist and first point of contact. Independently performs assigned duties. Interacts with all levels within and outside the organization to release or receive information and handles issues within scope of the role. Requires extensive knowledge of the HCBA program and related vendors operations; communicates directly with participants and facilitates appointments and follow up documentation.
Pay rate range for the Patient Care Navigator at CEI is $22.96 - $34.43 per hr. Pay rate range based on market for the Patient Care Navigator position as well as experience, skills, abilities and work history.
Duties and Responsibilities:
- Acts as part of the team that is the initial point of contact for all department calls.
- Explains the HCBA program’s criteria for eligibility, enrollment and waiver services
- Triages HCBA calls, voicemails, email and fax appropriately.
- Responsible for processing waiver application. Enters information in MedCompass. Tracks application status.
- Communicates with other county service providers to facilitate beneficiary care
- When necessary, refer applicants to the County Medi-Cal Office for determination of Medi-Cal eligibility.
- Sends out Plan of Treatment (POT) for signatures and other waiver forms and correspondence, including but not limited to mailing out Waiting List, Notice of Action and Informing Notice letters as directed. Tracks documents progress to completion.
- Provides administrative support for HCBA Case Management Team (CMT) for care coordination functions including printing/faxing/scanning of participant documents.
- Initiates phone screens interview to gather general information prior to RN’s facility/home assessment/reassessment visit.
- Interfaces with participants for data collection, scheduling and care coordination needs.
- Receives information and assures delivery to correct recipient, maintain strict confidentiality in handling medical records.
- Prepares Intake packet, POT, other clinical information prior to facility/home visit.
- Receives and communicates medical/ clinical information and notifies case manager as needed.
- Open to best practice model suggestions. Offers input and complies with department standards of care and practice as well as quality improvement activities.
- Listens to and documents participant concerns and facilitates satisfactory resolution. Escalate to HCBA supervisor or program director as needed.
- Assists with completion of reporting requirements
- Makes process improvement suggestions.
- Performs other duties as needed to support the HCBA team and assist with provision of care coordination services.
Qualifications:
• Associate degree or higher, and 3-5 years of progressively responsible experience related to health plan operations.
• Demonstrated excellent customer service, written and oral communication skills required
• Basic knowledge of PC’s and related software required. Accuracy, productivity, dependability and good attendance is critical.
• Ability to perform duties in heavy workload environment.
Preferred Qualifications:
• Experience working with diverse populations with complex medical needs. Experience in electronic medical records and advanced computer skills.
• Health plan experience with member coordination/communication and clerical management experience required (usually 3-5 years).
Center for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a "fee-for-service" plan. It is a “capitation” healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.