Clinical Care Quality Navigator

DESCRIPTION OF POSITION:

The Clinical Care Quality Navigator plays a crucial role in ensuring the delivery of high-quality, patient-centered care within the ambulatory physician clinic setting. This position requires a skilled healthcare professional with a strong background in clinical care, patient navigation, and quality improvement. The Clinical Care Quality Navigator is responsible for conducting outreach for annual wellness visits, navigating patients through the healthcare system, and closing care gaps to optimize patient outcomes and enhance overall quality of care.

Responsibilities:

Annual Wellness Visit Outreach:

• Conduct proactive outreach to eligible patients to schedule and promote annual wellness visits in accordance with preventive care guidelines.
• Educate patients about the importance of annual wellness visits, preventive screenings, and health maintenance activities to support proactive healthcare management.

Patient Navigation:

• Serve as a primary point of contact for patients, assisting them in navigating the healthcare system and accessing necessary services and resources.
• Provide guidance and support to patients in scheduling appointments, obtaining referrals, coordinating care transitions, and addressing healthcare-related concerns.

Gap Closure for HEDIS and other contracted quality measures:

• Identify care gaps through analysis of patient data, electronic health records (EHRs), and quality performance metrics.
• Collaborate with healthcare providers and care teams to develop and implement targeted interventions to close care gaps and improve adherence to recommended preventive care and treatment guidelines.
• Maintains and manages payor rosters.

Care Coordination:

• Facilitate communication and collaboration among healthcare providers, specialists, and ancillary services to ensure seamless care coordination and continuity of care for patients.
• Assist in the development and implementation of care plans tailored to individual patient needs and preferences.

Patient Education:

• Provide patient education on disease prevention, self-management strategies, medication adherence, and lifestyle modifications to support optimal health outcomes.
• Empower patients to become active participants in their healthcare journey by equipping them with the knowledge and tools needed to make informed decisions about their health.
• Conducts telephonic and face to face health risk assessments.
• Serves as central point of contact for annual wellness visits and coordinating communication with all team members to ensure that patients receive quality care.

Documentation and Reporting

• Maintain accurate and up-to-date documentation of patient interactions, care plans, and interventions in electronic health records (EHRs) or other designated systems.
• Generate reports and performance metrics to track progress in closing care gaps, improving quality metrics, and achieving organizational quality goals.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

EDUCATION AND WORK EXPERIENCE

• Medical Assistant (certified preferred) or Licensed Practical Nursing (LPN) License required.
• Minimum of five years of experience in a clinical healthcare setting, preferably in ambulatory care or primary care
• Strong understanding of preventive care guidelines, quality improvement initiatives, and value-based care principles.
• Excellent communication, interpersonal, and organizational skills.
• Proficiency in using electronic health record (EHR) systems and other healthcare-related software applications.
• Ability to work independently, prioritize tasks, and adapt to changing priorities in a fast-paced environment.
• Heartsaver CPR certification required.
• Working knowledge of Microsoft Office and high proficiency in technology to maintain databases and compile reports.
• Ability to communicate and interact professionally via telephone and in person with patients, families, and caregivers.
• High comfort level collaborating and communicating with physicians, advanced practice providers, patients, families, and other clinic employees.
• Self-directed and able to organize and manage multiple tasks/projects simultaneously. Extensive understanding of patient care.
• Proficient in review of medical records and other patient care information.
• Demonstrated skills in verbal and written communication.

Physical Demands/Work Environment

• Work involves a variety of physical activities including sitting, standing and walking.
• Bending stooping and lifting are minimal.
• Must be able to sit for long periods of time and utilize a PC.
• Must have normal hearing or utilize adaptive hearing devices.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.