Care Navigator at Upward Health

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

WHY IS THIS ROLE CRITICAL?

The Care Team is a multidisciplinary team of licensed and unlicensed staff who provide direct support and care to Upward Health’s patients. The Care Team is comprised of a diverse team that may include registered nurses, licensed social workers, pharmacists, therapists and paramedics, care navigators and care specialists. This team works within the community and in the patients’ homes or meet in agreed upon locations in the community.

The Care Navigator is responsible for ensuring a seamless patient experience as the single point of contact for the patient. The ideal candidate possesses career experiences in fast-paced provider office settings. Care Team staff are trained to provide extensive patient support and assistance. The Care Navigator offers a range of direct patient care support that includes community and medical referral aid, telephonic care coordination assistance to patients and providers, and clinical coordination across all medical and behavioral providers. Additionally, the Care Navigator assists the Care Team in utilization management.

KEY RESPONSIBILITIES:

• Single point of contact
  1. Coordinate with providers and Care Team members to provide ongoing support and communication to our patients and ensure a smooth continuum of care
  2. Monitor patient hospitalizations and follow up as necessary with Care Team staff
  3. Provide patients with educational materials and execute correspondence to primary care physicians and specialists for new patient enrollments/appointments
  4. Collect, verify, & coordinate clinical and administrative information (e.g., Hospitalizations, Insurance)
• Patient registration
  1. Perform outbound calls to patients to understand their clinical needs and connect them with appropriate resources
  2. Collect, enter, and/or confirm patient demographic, health, insurance, and payment information in EHR and related systems
  3. Help patients register for and access the EHR patient portal
  4. Explain Upward Health’s payment policy to patient
  5. Facilitate completion of new patient forms
• Insurance verification and authorization fulfillment
  1. Verify patient insurance information using insurance card and payers’ portals
  2. Contact payers for out-of-network inquires and to determine coverage policies
  3. Identify patient cost-sharing amount and enter in EHR and related systems
  4. Identify and complete prior authorizations for services and medications
  5. Monitor insurance changes and identify/research established patients who lose eligibility
• Scheduling & check-in
  1. Ensure that patient appointments with Upward Health providers are scheduled promptly and efficiently
  2. Manage patient appointment cancelation and rescheduling as needed
  3. Ensure patient missed appointments are rescheduled and communicated to the physician/clinician, patient, and members of the Care Team
  4. Maintain system of notifications sent to patients about scheduled appointments
  5. Attach any pre-visit paperwork to the patient’s EHR chart
  6. Ensure completion of as-needed patient clinical and administrative forms ahead of visits
  7. Contact patient in advance of or at beginning of appointment to complete check-in and:
     • Confirm demographic information
     • Confirm patient insurance eligibility
     • Review patient account balance and any co-payments due
     • Collect payment information from patients, including processing credit card payments for patient cost-sharing amounts
     • Notify patients of necessary future appointment details
  8. Provide minor technical assistance to ensure that patients can access virtual visits
• Follow Up Support from Provider Visits
  1. Assistant the providers delivering care as it relates to pre and post visit documentation, following up on orders, faxes, and labs, and ensuring smooth experience for patient and provider
  2. Perform outbound calls to providers to make appointment for patients or follow up on care
  3. Follow up with patients to ensure their needs are met and schedule future wellness discussions
  4. Expedite follow up to further coordinate next steps as to the patient response, scheduling needs and insurance coordination
• Various administrative support and other duties
  1. Lead the answering of the phone and responding to the fax machine for patient inquires
  2. Answer inbound calls from patients, providers, and Upward Health resources as necessary
  3. Collaborate with Finance colleagues on patient billing issues
  4. Handle medical record requests
  5. Manage the incoming queue of patient referrals
  6. Prepare reports and documents as needed or requested, ensures Care Team is following proper documentation protocols at the direction of the Manager
  7. Attend regular team meetings and participate in clinical rounds
  8. Maintain patient, provider, & payer contact & referral Information
  9. Other duties as assigned

KNOWLEDGE, SKILLS & ABILITIES:

• Interpersonal savvy, with the demonstrated by the ability to interact with and influence people to establish trust and build strong relationships
• Practice an extreme sense of urgency and ‘can-do’ attitude required for a role at a start-up company
• Strong organizational skills and ability to juggle multiple high-priority tasks and maintain a personal schedule
• Strong attention to detail to ensure that work is completed accurately and completely
• Ability to establish priorities and meet deadlines
• Flexibility to change course and take on additional responsibilities as the business requires
• Ability to work independently within a virtual operating environment and as part of a team
• Excellent oral and written communication skills
• Ability to exercise judgment in the application of professional services
• Comfortable with computer data entry
• Multi-lingual capabilities preferred, but not required

QUALIFICATIONS:

• 3+ years at an outpatient healthcare practice serving as a patient representative or similar experience
• High school graduate or GED required
• Prior experience in health insurance and medical terminology is preferred
• Knowledge of community resources in applicable geographic area
• Able to maintain clear professional boundaries with members and coworkers
• Cultural competency – able to work with diverse groups of community members
• Highly technologically savvy
• Report development from clinical and non-clinical systems
• Ability to assist with development and distribution of educational materials

Upward Health is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce.

This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.