Quality of Care Navigator

ob Roles

• Assist with establishing managed care patients’ medical homes and care with a primary care provider within 90-120 days of insurance coverage date.
• Conduct routine queries of FHCSD electronic health record (EHR) system to identify patients that need preventative screenings (T2DM, cancer screening, wellness visits, immunizations etc.) to improve quality measure performance.
• Improve quality measure performance through engaging members, schedule clinic appointments, provide an overview of the preventative screening processes and, advocate patients on following up for screening appointments.
• Assist patients via telephone and in person with assessing potential barriers to care and identifies supportive steps to overcome these barriers, assisted and unassisted referrals, resources and follow-up; including linguistic needs, learning style preferences and transportation needs. Assists with navigational support to overcome identified barriers depending on patients presenting needs.
• Provide patient care within scope
• Support provider productivity, complete patient orders accurately. Document patient Vital Signs and pre-assessment questions. Discharge patients with appropriate instructions. Consistently follows Policies and Procedures to ensure positive patient outcomes.
• Work closely with medical provider to assist with completion of prior authorization and Patient Assistance Program requests.
• Complete all required documentation accurately and thoroughly in accordance with department standards, and ensure documentation complies with the patient’s insurance requirements.
• Assist in preparing monthly, quarterly, and annual reports to the corresponding supervisory and funding sources.
• Attend nursing in-services or complete make-up assignments.
• Perform thorough follow-up on select referral orders from providers, maintaining timely accurate documentation of all efforts and outcomes.
• Ensure applicable regulatory and department standards are met or exceeded and adhered to on an on-going basis (JCAHO, OSHA, PCMH, etc.).
• Provide non-biased assistance to managed care patients to include but not limited to modifying and/or selecting their primary care provider or assigned clinic, assisting patients in filing appeals/grievances, communicating with managed care plan staff and acting as a liaison between FHCSD and managed care plans.
• Consistently follow policies and procedures to ensure positive patient outcomes.
• Make reminder and follow up telephone calls.
• Perform other duties as assigned.

Requirements:

• Medical Assistant diploma from an approved course required.
• Current American Heart Association healthcare provider CPR (BLS), or Advanced Cardiac Life Support, Advanced Trauma Life Support, or Advance Resuscitation Training required.
• High school diploma or GED equivalent required.
• Or equivalent combination of education and experience that provides the skills, knowledge and ability to perform the essential job duties, and which meets any required state or federal certification requirements.
• Ability and means to travel as needed in a timely manner within San Diego County, to locations that may have limited access to public transportation; proof of liability and property damage insurance on vehicle used is required. DRIVER REQUIREMENTS: Age 21; Licensed for a minimum of 3 years; No violations and/or accidents within 3 years; No vehicle related suspensions/reinstatements; No DUI, reckless or felony Driving within 7 years.