Non-Commercial HMO Members require an additional degree of assistance in regard to coordination and navigation between sites of care. Members who reside outside of the current Kaiser Permanente Northwest footprint, or are covered by a non-Commercial HMO benefit, often receive care from a non-Kaiser physician, clinic or hospital. These patients require assistance in determining the best course of care based on resources available between Kaiser and non-Kaiser providers. This role is critical to ensure that member’s are provided with the highest quality care within the parameters of their providers, benefits, and group structure. Essential Functions:
• Patient coordination/navigation: Review the details and expectations about the referral with the member. Assist patients in problem solving potential issues related to health care delivery, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance). Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns. May assume advocate role on the patient’s behalf to ensure approval of the necessary services for the member in a timely fashion. Identify and utilize cultural and community resources in concert with the Social Work department. Establish and maintain relationships with identified service providers. Remind patients of scheduled appointments via phone.
• Documentation and information coordination: Maintain ongoing tracking and appropriate documentation on referrals for Out of Area members to promote team awareness and ensure patient safety. Ensure member integration into the KP care delivery system, with consideration of patient demographic and current provider information. Develop member profiles for information concerning patient’s clinical background and referral needs. Ensure that patient’s primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.
• Incorporates Principles of Responsibility into duties, communications and interactions.
• Performs other duties as assigned.
QualificationsBasic Qualifications: Additional Requirements:
• Minimum one (1) year of clinical experience working with patients to achieve appropriate care outcomes.
• High School Diploma or General Education Development (GED) required.
• One-two (1-2) years of college or technical training.
License, Certification, Registration
• Dedication to achieving the care to match patient care outcomes based on benefit.
• Strong customer service focus.
• Ability to coordinate multiple components of care to support patient needs.
• Work on tight timelines.
• Effective verbal and written communication skills.
• Teamwork orientation.
• Organized and able to manage competing priorities.
• Good judgment.
• Resourcefulness in problem solving.
• Medical terminology.
• Able to take and follow through with delegated tasks and accountability.
• Familiarity with and ability to use computers; able to type 30 WPM with 80% accuracy.
• Demonstrated ability to work as part of a team and work as a constant patient advocate. Preferred Qualifications:
• Minimum three (3) years of experience in health related customer service, medical office practice or other patient-related experience in the ambulatory setting. • Experience with outreach programs. • Previous patient navigation or care coordination experience. • Associate’s degree in business administration, communication, marketing, or health related field. • Excellent oral and written communication skills and demonstrated ability to establish rapport with patients/members. • Ability to manage multiple work priorities and requests from members. • Demonstrated ability to effectively use Microsoft Word and Excel and the ability to quickly learn new computerized systems such as appointing programs. • Must demonstrate initiative and excellent problem solving skills. • Knowledge of benefit composition and authorization of services. • Adherence to timelines and schedules. • Demonstrated ability to interrelate with physicians, nurses and patients. • Demonstrates customer-focused service skills. • Good clinical judgment to assess the needs of patients as they relate to next level of care. • Knowledge of Medicare and Medicaid regulations related to eligibility requirements: hospital, nursing facilities, home health and hospice eligibility requirements. • Knowledge of Kaiser Permanente and community resources.
Primary Location:Oregon-Portland-Kaiser Permanente Building 500 NE Multnomah St.Scheduled Hours (1-40):40Shift:DayWorking Days:Mon, Tue, Wed, Thu, FriWorking Hours Start:8:00 AMWorking Hours End:5:00 PMSchedule:Full-timeJob Type:StandardEmployee Status:RegularEmployee Group (Union Affiliation):Non-Union, Non-ExemptJob Level:Individual ContributorJob:Customer ServicesPublic Department Name:Resource StewardshipTravel:NoJob Eligible for Benefits:YesExternal hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.