Tamheer - Care Navigator

<div><p>The Care Navigator is responsible for operational care coordination and patient-facing communication within clinical programs. The role ensures timely follow-up, accurate dissemination of medical information, and seamless navigation of members through approved healthcare services in alignment with established clinical pathways and internal policies with a goal for members to have coordinated care throughout their journey and improve their health outcomes.</p><h3>Patient Care Navigation&Case Coordination</h3><ul><li>Act as the primary point of contact for members enrolled in clinical programs.</li><li>Guide patients through approved care pathways, explaining service processes, requirements, and next steps.</li><li>Coordinate internally to ensure timely processing of healthcare service requests (appointments, referrals, approvals).</li><li>Maintain accurate documentation of all member interactions in the system.</li><li>Collaborate with healthcare providers, patients, and their families to facilitate effective care management and improve health outcomes.</li></ul><h3>Communication of Clinical Information and Patient Education</h3><ul><li>Provide clear, accurate explanations to members regarding their medical service requests, approvals, and program enrollment status.</li><li>Translate medical terminology into patient-friendly language while maintaining clinical accuracy.</li><li>Escalate complex clinical inquiries to appropriate clinical supervisors or physicians when required.</li><li>Facilitate communication between patients and healthcare providers to ensure continuity of care.</li></ul><h3>Operational Support to Clinical Programs</h3><ul><li>Support the execution of clinical programs by tracking patient milestones and adherence to assigned pathways.</li><li>Monitor enrollment, follow-up schedules, and required documentation.</li><li>Assist in coordinating multidisciplinary interactions when required (e.g., providers, digital services, internal teams).</li><li>Arrange necessary resources and services for patients, including referrals to specialists, community services, and support programs.</li></ul><h3>Service Request Monitoring&Follow-Up</h3><ul><li>Track healthcare service requests from initiation to completion.</li><li>Follow up with relevant departments (medical approvals, provider network, customer service) to prevent delays.</li><li>Notify members of updates within agreed service level timelines.</li></ul><h3>Data Entry, Reporting&Documentation Compliance</h3><ul><li>Ensure accurate entry of case notes, updates, and program-related activities into internal systems.</li><li>Maintain confidentiality and compliance with healthcare data protection regulations.</li><li>Support supervisors with basic operational reporting (e.g., caseload status, follow-up completion rates).</li></ul><h3>Patient Experience&Service Quality Support</h3><ul><li>Address patient concerns related to care navigation within scope of authority.</li><li>Identify recurring operational issues and elevate them to management.</li><li>Contribute feedback to improve communication workflows and patient journey processes.</li></ul><h3>Skills</h3><ul><li>Strong understanding of medical terminology and basic clinical pathways.</li><li>Familiarity with healthcare authorization and service request processes.</li><li>Proficiency in healthcare information systems and documentation tools.</li><li>Clear verbal and written communication skills.</li><li>Ability to manage multiple cases simultaneously with attention to detail.</li></ul><h3>Education</h3><p>Bachelor’s degree in Nursing, Health Sciences, Public Health, or related healthcare field</p></div>#J-18808-Ljbffr