Connected Care Patient Navigator

Job Details

This role is crucial for delivering exceptional patient service and conducting Health Related Social Needs (HRSN) assessments in various clinical and community settings. It involves performing screenings for HRSN as well as other critical health-related screening (e.g., assessing for missed/delayed cancer screenings), documenting results, and validating patient information to ensure maximum service benefits. The position also includes implementing optimal referrals, educating patients on resources, and providing follow-up support to ensure receipt of services. Regular communication with Connected Care Services staff and collaboration with the care team are essential to maintain organized records and provide culturally humble interactions.

Job Description

Essential Functions

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.

Patient Experience and Service Excellence

• Deliver exceptional service and resolve every transaction with the highest level of professionalism, ensuring a patient experience that reflects our unwavering commitment to efficient and effective care connections. Demonstrate dedication to service excellence and consistent follow-through.

Screening Responsibilities

• Conduct Health Related Social Needs (HRSN) assessments onsite in various clinical and community settings for patients and community members.
• Engage with patients who present to clinical care settings to 1) determine whether they have a missed/delayed cancer screening and 2) educate patients who do have a missed/delayed cancer screenings about the importance of receiving screening as well as pathways to pursue future screening. 
• Accurately document screening results and adhere to workflows to communicate positive screenings to relevant staff.
• Validate demographics and other essential registration fields (e.g., PCP, telephone number, address, email) by obtaining and/or confirming patient information to maximize service benefits.
• Support patient’s digital literacy by training them in how to use tools such as MyChart.

Referral Management and Education

• Implement optimal HRSN referrals for individuals based on screening results, with support from referral specialists.
• Educate patients on available resources, guide them on independent access (e.g., setting up rides), and assist in completing necessary paperwork for program approval (e.g., insurance applications).
• Provide targeted education to patients who are identified to have a missed/delayed cancer screening, including relevant factors about importance of screening as well as supporting connection in for patients as relevant to future screenings.
• Conduct follow-up assessments and provide ongoing support to ensure individuals receive services related to referrals (loop closure). For many patients, this will include troubleshooting cases in which resources were not received.
• Schedule medical appointments for patients as needed.

General Duties

• Maintain regular communication with Connected Care Services staff.
• Collaborate with the care team regarding HRSN results, interventions, and update the team on referral outcomes and patient satisfaction with resources.
• Ensure organized and secure record-keeping of screenings and timely data entry.
• Apply cultural humility in interactions with clients and staff.
• Operate with a high level of independence, as staff will often be working without other team members onsite across Enterprise locations
• In many locations, this will be a new workflow that requires ongoing attention to achieve clinical staff buy in and partnership, that this staff member will play a critical role in as the person working on site daily

Work Shift

Rotating (United States of America)

Worker Sub Type

Regular

Employee Entity

Thomas Jefferson University

Primary Location Address

914 Chestnut Street, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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