Care Navigator

Bachelor's degree from an accredited institution preferred. Minimum of 3 years of experience in transitions of care or related healthcare settings. Proficiency in using virtual visit platforms, EHRs, and scheduling systems. Strong verbal, written, and organizational skills. Ability to work effectively in a diverse team. Experience collecting and documenting clinical and demographic data accurately and in a timely manner. Strong problem-solving skills. Ability to make sound decisions and collaborate effectively. Adaptable and resourceful, with a growth mindset. Ability to thrive in a fast-paced, evolving environment. Proven ability to establish cooperative working relationships. Bilingual fluency in Spanish (written and verbal) preferred.

Collaborate with physicians, discharge planners, social workers, and primary care providers for safe care transitions. Conduct patient assessments to identify barriers to successful discharge. Create and implement individualized care plans. Educate patients and families on medications, treatments, follow-up appointments, and lifestyle changes. Educate patients on recognizing warning signs requiring urgent care. Schedule and monitor adherence to follow-up appointments with PCPs, specialists, or community services. Conduct post-discharge follow-ups to track progress and address needs. Act as a liaison between patients, caregivers, and providers. Document interactions, progress, and follow-ups in electronic health record systems. Report patient outcomes to refine processes and improve care coordination. Work closely with multidisciplinary teams and participate in case reviews.