Care Navigator

Job Description

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.

Patient Care Navigation & Case Coordination

• Act as the primary point of contact for members enrolled in clinical programs.

• Guide patients through approved care pathways, explaining service processes, requirements, and next steps.

• Coordinate internally to ensure timely processing of healthcare service requests (appointments, referrals, approvals).

• Maintain accurate documentation of all member interactions in the system.

• Collaboarte with healthcare providers, patients, and their families to facilitiate effective care management and improve health outcomes.

Communication of Clinical Information and Patient Education

• Provide clear, accurate explanations to members regarding their medical service requests, approvals, and program enrollment status.

• Translate medical terminology into patient-friendly language while maintaining clinical accuracy.

• Escalate complex clinical inquiries to appropriate clinical supervisors or physicians when required.

• Facilitate communication between patients and healthcare providers to ensure continuity of care.

Operational Support to Clinical Programs

• Support the execution of clinical programs by tracking patient milestones and adherence to assigned pathways.

• Monitor enrollment, follow-up schedules, and required documentation.

• Assist in coordinating multidisciplinary interactions when required (e.g., providers, digital services, internal teams).

• Arrange necessary resources and services for patients, including referrals to specialists, community services, and support programs.

Service Request Monitoring & Follow-Up

• Track healthcare service requests from initiation to completion.

• Follow up with relevant departments (medical approvals, provider network, customer service) to prevent delays.

• Notify members of updates within agreed service level timelines.

Data Entry, Reporting & Documentation Compliance

• Ensure accurate entry of case notes, updates, and program-related activities into internal systems.

• Maintain confidentiality and compliance with healthcare data protection regulations.

• Support supervisors with basic operational reporting (e.g., caseload status, follow-up completion rates).

Patient Experience & Service Quality Support

• Address patient concerns related to care navigation within scope of authority.

• Identify recurring operational issues and escalate them to management.

• Contribute feedback to improve communication workflows and patient journey processes.

Skills

• Strong understanding of medical terminology and basic clinical pathways.

• Familiarity with healthcare authorization and service request processes.

• Proficiency in healthcare information systems and documentation tools.

• Clear verbal and written communication skills.

• Ability to manage multiple cases simultaneously with attention to detail.

Education

Bachelor’s degree in Nursing, Health Sciences, Public Health, or related healthcare field