Patient Care Navigator

Description

The Patient Care Navigator provides patient engagement, care coordination, and population health support services for a physician-owned, value-based ambulatory primary care organization serving Medicare Advantage and Commercial PPO/HMO members across multiple California counties.

Operating within a hub-and-spoke care model, the Patient Care Navigator serves as a primary point of contact for patients and supports care delivery through telephonic outreach, appointment coordination, preventive care engagement, and care gap closure activities. Working closely with the Medical Director, Advanced Practice Provider (APP), Registered Nurse (RN), Pharmacist, Community Health Workers (CHWs), and specialty providers, the Patient Care Navigator helps patients navigate the healthcare system, access needed services, and remain engaged in their care plans. This role supports Annual Wellness Visit (AWV) completion, chronic disease management, referral coordination, specialty access, and achievement of value-based care performance goals.

Position Description:

• Serves as a primary point of contact for patients, caregivers, and community partners.
• Schedules telehealth and in-person appointments with physicians, APPs, pharmacists, specialists, and other care team members.
• Conducts patient intake, registration, insurance verification, and demographic updates.
• Coordinates referrals, specialty appointments, diagnostic testing, and follow-up services.
• Assists with prior authorization requests and tracks authorization status.
• Performs outreach to schedule Annual Wellness Visits (AWVs), preventive screenings, chronic care follow-up appointments, and quality gap closure initiatives.
• Monitors appointment adherence and conducts outreach to reduce no-shows and missed visits.
• Supports patient onboarding and education regarding telehealth technology and practice workflows.
• Coordinates communication among providers, Community Health Workers, pharmacists, nurses, and external healthcare organizations.
• Receives patient inquiries and escalates clinical concerns to licensed clinical staff in accordance with organizational protocols.
• Supports care transitions following hospitalizations, emergency department visits, and specialty care encounters.
• Maintains accurate and timely documentation within the Electronic Medical Record (EMR) and other designated systems.
• Participates in interdisciplinary care team meetings and population health initiatives.
• Supports achievement of organizational goals related to access, patient experience, quality performance, and value-based care outcomes.

Qualifications

• High school diploma or equivalent required.
• Associate degree or healthcare-related certification preferred.
• Minimum two (2) years of experience in a medical office, physician practice, care coordination, scheduling, referral management, or healthcare customer service role preferred.
• Experience supporting Medicare Advantage, managed care, primary care, or value-based care programs preferred.
• Experience with referral management, prior authorizations, and appointment scheduling preferred.
• Experience using Electronic Medical Record (EMR) systems required.
• Bilingual English/Spanish preferred.

Working Knowledge of the Following Required

• Medical office operations and patient scheduling workflows.
• Medicare Advantage and commercial payer programs.
• Referral management and prior authorization processes.
• Customer service and patient engagement principles.
• Telehealth care delivery models.
• Electronic Medical Record (EMR) systems and healthcare technology platforms.

Examples of Competencies

• Strong customer service and patient engagement skills.
• Excellent organizational and follow-up abilities.
• Ability to manage multiple priorities in a fast-paced healthcare environment.
• Strong communication and interpersonal skills.
• Attention to detail and documentation accuracy.
• Ability to work collaboratively within interdisciplinary care teams.
• Professionalism, accountability, and problem-solving capabilities.
• Commitment to patient-centered service and operational excellence.

Benefits:

As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities, and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/why-cope-health-solutions/.

About COPE Health Solutions
COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit .

To Apply:

To apply for this position, or to view all available positions, visit us at https://copehealthsolutions.com/careers/open-positions/.