Patient Navigator

Neighborhood Health is an innovative network of 12 community health centers in Nashville, Lebanon, and Gallatin, Tennessee. We provide comprehensive primary care, integrated behavioral health, and dental services to almost 30,000 patients. Our patients primarily include immigrants, residents of public housing, individuals experiencing homelessness, and persons living with addiction. As a federally qualified health center, we provide care without regard to health insurance or a patient's ability to pay. We also strive to improve our Patient Centered Medical Home (PCMH) model to ensure all of our patients get the right high-quality care, at the right place, and at the right time.

This position will report to the Manager of Patient Navigation.

Patient Navigator

NATURE OF POSITION:

The Patient Navigator will work within Neighborhood Health communities to enroll members in programs such as TennCare, CoverRx and the Federal Health Insurance Marketplace. Furthermore, it will be the responsibility of this individual to coordinate ongoing care between patients and practitioners. The Patient Navigator may also be required to represent Neighborhood Health at community events.

QUALIFICATIONS:

Education and Experience

Graduation from an accredited college or university with a bachelor's degree, associate's degree or experience equivalent. Qualifying full-time eligibility determination experience, experience in a clinical setting or similar experience at a professional, paraprofessional or technical level of three years or more.

Skills

• Active listening and learning skills
• Basic computer skills
• Basic mathematical skills
• Able to communicate effectively, both verbal and written, as appropriate for the needs of the audience.
• Critical thinking, problem-solving and decision-making skills
• Effective organizational and time management skills
• Exceptional interpersonal skills
• Excellent reading comprehension skills
• Spanish speaking preferred
• Experience with TennCare, CoverRx and the Federal Health Insurance Marketplace is preferred

Abilities

• Flexibility and adaptability to various environments and regulations
• Able to be objective
• Combines pieces of information to form conclusions
• Communicates information and ideas in a manner tailored to the audience
• Concentrates on tasks over a period of time without getting distracted
• Multi-tasks with competing priorities
• Retains information
• Works as part of a team
• Able to work with diverse populations

ESSENTIAL JOB FUNCTIONS:

Enrollment

• Ensures:

• uninsured children and uninsured pregnant women apply for TennCare/CoverKids on or before their date of service;

• uninsured parents/caretaker relatives of minor children under the federal poverty level apply for TennCare on or before their date of service;

• uninsured adults age 18-64 under the federal poverty level apply for CoverRx on their date of service; and

• Medicare enrollees who are at or below 135% of the federal poverty level apply for the Medicare Savings Program on their date of service.

• Ensures those patients ineligible for health coverage programs apply for and enroll in pharmacy patient assistance programs (PAPs) so these patients can obtain the prescription medications they need.

• Remains up-to-date on new policies and procedures as they are implemented in order to ensure accurate eligibility determination and enrollment.

• Successfully complete all required and applicable federal and/or state consumer assistance training.

• Makes decisions by analyzing information related to client's eligibility to ensure appropriate policy and procedures are applied.

• Calculates accurate income based on information provided by clients and obtained through other sources to determine eligibility.

• Documents required verifications, services, benefits provided, and other case-related activity using a computerized case record and/or paper case files.

• Properly stores and maintains case related documentation to ensure program integrity and client confidentiality.

• Documents reports of activities and outcomes as required.

• Obtains documentary evidence to support client information to ensure proper eligibility determination.

• Interviews clients to obtain information related to their eligibility for government assistance programs.

• Explains eligibility for benefits and services, as well as ongoing responsibilities, to ensure client understanding.

• Uses computer systems to enter client information to determine eligibility and ensure clients receive proper notifications.

• Explains rules, regulations, policies, procedures, and benefits determinations to clients or other interested parties to ensure program availability.

• Communicates verbally and/or electronically with outside organizations or vendors to provide information regarding client eligibility.

Care Coordination

• Understands that Neighborhood Health is a Joint Commission Accredited facility and is obligated to abide by Joint Commission Standards.
• Identifies clients with the potential for high-risk complications and coordinate the appropriate supported self-care in conjunction with the client and care coordination team.
• Recognizes and takes appropriate actions to resolve gaps in care.
• Develop and implement targeted strategies to improve health, functional or quality of life outcomes, such as disease management or pharmacy management.
• Compare client's plan of care to establish pathways to determine variances and then intervene as indicated.
• Responsible for providing materials for morning huddle.
• Enroll uninsured and underinsured patients in Patient Assistance Programs.
• Meet with new clients to address questions or concerns during post-visit summary.

General

• Resolves general client concerns regarding agency programs, policies, and procedures to assist customers.
• Provides referrals to applicable offices to address client grievances, complaints or questions.
• Provides information and assistance in a fair, accurate, culturally appropriate and impartial manner.
• Enters required documents and information into various databases and filing systems for future retrieval.
• Promotes a positive image of Neighborhood Health by focusing on great service while fulfilling the organization's mission.
• Communicates verbally and/or electronically with outside organizations to obtain information regarding client circumstances.
• Provides information and support to co-workers, vendors, and clients to meet their immediate and long-term needs.
• Identifies benefits and services that might be available to clients both from the insurance exchange and from related sources to assist in meeting client needs.
• Establish and maintain professional working relations with referral sources, community resources and care providers.
• This list may not be inclusive of the total scope of job functions to be performed.
• Duties and responsibilities may be added, deleted or modified at any time.

WORK SCHEDULE: 40 hour work week. Must be willing to occasionally work nights or weekends.

SALARY GRADE AND CLASSIFICATION: Non-exempt, Full-Time

SUPERVISORY RESPONSIBILITIES: None

RESPONSIBLE TO: Manager of Patient Navigators

PHYSICAL REQUIREMENTS:

Work is varied in nature and is performed with frequent interruptions. Work requires close attention to detail, accuracy, documentation and timeliness in fulfilling duties and reports. Work requires sitting, standing, and/or walking for periods of five hours or more, moving and examining objects at high and low reach.