Mgr Patient Care Navigator - Show Low, United States - Summit Healthcare Regional Medical Center

Description

The following information is designed to outline the functions and position requirements of this job. It does not identify all tasks that may be expected, nor address the performance standards that must be maintained.


General Position Summary:

The Patient Care Navigator leads the development, implementation, and administration of the organization's Patient Care Navigator team.

This role will be responsible for establishing and maintaining best practices related to care coordination, healthcare collections, and navigation of payer specific guidelines.

The Patient Care Navigator manager will also be responsible for oversight and communication of metrics related to pre-service collections, quality auditing, service recovery, and patient satisfaction.

The candidate will provide work direction to subordinate staff in the day-to-day performance of their jobs and trains departmental staff as needed.

This leader ensures that project/department milestones/goals are met and adhering to approved budgets.

This role maintains extensive knowledge of department processes to include, but not limited to, pre and patient access functions, collection activity, budgets, reporting, quality metrics, etc.

This position will frequently be responsible for communication and collaboration strategies with both internal and external care teams.


Essential Functions / Major Responsibilities:

• Coordinates patient care based on referrals/order/requests from clinicians
• Creates, tracks, manages, modifies, and monitors patient authorizations as they relate to the treatment plan and in alignment with payer requirements
• Creates, tracks, manages, modifies, and monitors patient authorizations as they relate to the treatment plan and in alignment with payer requirements
• Organizes schedules and manages appointments for patients to ensure they receive services in a timely manner
• Regularly creates and discusses with the patient any financial estimates for care
• Help patients and their families navigate the process of using insurance to pay for care and educates patients on coverage and limitations
• Connects the patient to financing and/or financial assistance options based on client need and organizational policy
• Responsible for gathering patient data (demographics)
• Schedules/Registers/pre-registers patients for treatment
• Verifies insurance via verification tool
• Collects patient portions of fees and posts appropriately in the EMR
• Conducts daily reconciliation of all collections
• Participates in departmental and hospital-wide informational meetings and in-services, including staff meetings, hospital-wide forums, and seminars.
• Displays proper etiquette and mannerisms that reflect the SHINE Behavior Standards.
• Promotes the Patient Safety Standards as a core value of the organization.
• Communicates treatment options to the patient as directed by clinicians
• Perform related tasks to make it easier for patients to receive the best possible health care at our hospital
• Provide advocacy, patient education and support in accessing community-based and hospital-based programs
• Assists in creating and directing communication to the referring physician to include, but not limited to, diagnostic reports, care summaries, referral outcomes, etc

Other Responsibilities:

• Responsible for data quality auditing and communicates to staff regarding opportunities for improvement to uphold and exceed performance standards
• Responsible for point of service collection reporting and communicates to staff regarding opportunities for improvement to uphold and exceed performance standards
• Responsible for service recovery reporting and communicates to staff regarding opportunities for follow up and care coordination
• Responsible for soliciting patient and provider feedback and formulating this feedback into actionable insights
• Responsible for policy review as applicable to their area of leadership
• All other duties as assigned

Job Knowledge:

• Must have excellent problem-solving skills and be able to independently solve issues related to the patient revenue cycle
• Must be able to communicate effectively.
• Must be able to coordinate multiple projects simultaneously.
• Must be able to monitor multiple data points/metrics simultaneously.
• Understand interactions/workflow between financial and clinical areas.
• Must demonstrate attention to detail.
• Advanced computer system administration and technical skills required.
• Must have excellent critical thinking skills and be able to independently solve complex issues related to care navigation and payer requirements
• Must be able to communicate effectively across multiple forums
• Must demonstrate advanced knowledge of healthcare coverage limitations, requirements, and financial liability
• Must be have knowledge of grant, private, and public financial assistance organizations
• Must be able to understand and communicate data effectively
• Must be able to assist in department budget management

Supervisory Responsibility:

• Provides work direction to subordinate staff in the day-to-day performance of their jobs and trains departmental staff as needed
• Responsible for creating subordinate reviews, providing ongoing associate coaching,

and performance improvement plans when necessary.


Interpersonal Skills:

• Exceptional customer-service orientation
• Ability to interact effectively with colleagues, providers, clinic staff, hospital staff, administration, patients, public and outside technical people.
• Effectively communicate and educate both peers and patients via written communication forums
• Ability to collaborate across multi-disciplinary teams both internally and externally
• Ability to effectively communicate to key leadership positions

Education and/or Experience:

• High school diploma or equivalent (required).
• 3-5 years related experience in healthcare, pre or patient access, revenue cycle or related area (required)
• 1-3 years of supervisory experience (required)
• Experience with electronic medical systems
• Advanced computer literacy required
• CRCR (preferred)
• Marketplace experience (preferred)
• Strong understanding of the needs and obstacles faced by the local patient population
• Strong communication skills
• Bilingual (English/Spanish) preferred
• Knowledge of healthcare payer regulation and guidelines
• Extensive knowledge of healthcare coverage tiers/product lines
• Medical terminology (preferred).

OSHA Exposure Category:

Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues and are not a condition of employment.