Coordinates medical appointments, assists patients in addressing their barriers to medication regimen adherence, actively works with patients to increase adherence to scheduled appointments, and coordinates follow up with non-clinical services such as transportation, home health, homeless shelters, home meal delivery, etc. The patient care navigator will actively engage with patients and caregivers both in the practice/clinic and over the phone using critical thinking and communication skills to identify barriers that may be impacting the patients ability to achieve optimal health.