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Quality of Care Navigator

Company: Family Health Centers of San Diego
Location: San Diego
Posted on: March 18, 2023

Job Description:

Impact Lives, Impact Community

Family Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in the country. With over 62 sites, over 227,000 patients, and over 417,000 visits last year, we provide a wide variety of health care and outreach services to a very diverse patient population. We are proud of our mission, our lasting community impact, and the cultural and individual diversity of our staff.

Job Roles

  • In collaboration with the interdisciplinary care team, assist patients in establishing care with primary care provider to improve each patients' physical and mental health that has deteriorated with the onset of the COVID-19 pandemic.
  • Provide needed support to ensure access to care, maintaining compliance with preventative and quality care tests, screenings, and visits.
  • Assist with establishing managed care patients' medical homes and care with a primary care provider within 90-120 days of insurance coverage date.
  • Conduct routine queries of FHCSD electronic health record (EHR) system to identify patients that need preventative screenings (T2DM, cancer screening, wellness visits, immunizations etc.) to improve quality measure performance.
  • Improve quality measure performance through engaging members, schedule clinic appointments, provide an overview of the preventative screening processes and, advocate patients on following up for screening appointments.
  • Assist patients via telephone and in person with assessing potential barriers to care and identifies supportive steps to overcome these barriers, assisted and unassisted referrals, resources and follow-up; including linguistic needs, learning style preferences and transportation needs. Assists with navigational support to overcome identified barriers depending on patients presenting needs.
  • Provide patient care within scope.
  • Support provider productivity, complete patient orders accurately. Document patient Vital Signs and pre-assessment questions. Discharge patients with appropriate instructions. Consistently follows Policies and Procedures to ensure positive patient outcomes.
  • Work closely with medical provider to assist with completion of prior authorization and Patient Assistance Program requests.
  • Complete all required documentation accurately and thoroughly in accordance with department standards, and ensure documentation complies with the patient's insurance requirements.
  • Assist in preparing monthly, quarterly, and annual reports to the corresponding supervisory and funding sources.
  • Attend nursing in-services or complete make-up assignments.
  • Perform thorough follow-up on select referral orders from providers, maintaining timely accurate documentation of all efforts and outcomes.
  • Ensure applicable regulatory and department standards are met or exceeded and adhered to on an on-going basis (JCAHO, OSHA, PCMH, etc.).
  • Provide non-biased assistance to managed care patients to include but not limited to modifying and/or selecting their primary care provider or assigned clinic, assisting patients in filing appeals/grievances, communicating with managed care plan staff and acting as a liaison between FHCSD and managed care plans.
  • Consistently follow policies and procedures to ensure positive patient outcomes.
  • Make reminder and follow up telephone calls.
  • Grant funded program. This position is funded through 03/31/2023; continuation of employment is dependent upon availability of and/or renewed funding.
  • Perform other duties as assigned. Education/Certifications/Licenses/Registrations
    • Medical Assistant diploma from an approved course required.
    • Current American Heart Association healthcare provider CPR (BLS), or Advanced Cardiac Life Support, Advanced Trauma Life Support, or Advance Resuscitation Training required.
    • High school diploma or GED equivalent required.
    • Or equivalent combination of education and experience that provides the skills, knowledge and ability to perform the essential job duties, and which meets any required state or federal certification requirements.
    • Ability and means to travel as needed in a timely manner within San Diego County, to locations that may have limited access to public transportation; proof of liability and property damage insurance on vehicle used is required. DRIVER REQUIREMENTS: Age 21; Licensed for a minimum of 3 years; No violations and/or accidents within 3 years; No vehicle related suspensions/reinstatements; No DUI, reckless or felony Driving within 7 years. Experience/Specialized skills (including Language)
      • At least 2 years' experience in ambulatory care or similar setting preferred.
      • Experience providing case management, care coordination/patient navigation and/or patient advocacy preferred.
      • Knowledge of adult health coaching and outreach techniques, best practices, and tools.
      • Knowledge of clinical services and support programs.
      • Knowledge of electronic health record (EHR) systems to include ability in identifying patients.
      • Knowledge of components found in various healthcare insurance plans.
      • Knowledge of health and social service systems in San Diego County is preferred
      • Ability to maintain good interpersonal interactions with patients and co-workers as a member of a multi-disciplinary community health team with a diverse multi-cultural population.
      • Ability to work effectively with patients from diverse social, cultural, and economic groups.
      • Bilingual English/Spanish preferred.
      • Strong interpersonal and customer services skills.
      • High level of Intermediate written and verbal communication skills, to include ability to communicate effectively with patients and family members who speak English as a second language.

        Physical Requirements/Working Environment

        Bending (neck): OCCASIONALLY (1 - 3 HRS)

        Bending (waist): RARELY (0-1 HRS)

        Carrying 0 - 10 lbs: RARELY (0-1 HRS)

        Carrying 11 - 25 lbs: NEVER

        Carrying 25 - 50 lbs: NEVER

        Carrying 51 - 75 lbs: NEVER

        Carrying 75 lbs: NEVER

        Climbing (ladder): NEVER

        Climbing (stairs): RARELY (0-1 HRS)

        Driving: To drive from one clinic or another, or in the community: Regular Driving (More than 3 Days/Week)

        Exposure to blood borne pathogens and biohazards: Yes

        Exposure to dust, gas, fumes, or chemicals: Office supplies

        Fine manipulation: OCCASIONALLY (1 - 3 HRS)

        Kneeling: RARELY (0-1 HRS)

        Lifting 0 - 10 lbs: RARELY (0-1 HRS)

        Lifting 11 - 25 lbs: NEVER

        Lifting 25 - 50 lbs: NEVER

        Lifting 51 - 75 lbs: NEVER

        Lifting over 75 lbs: NEVER

        Power Grasping: OCCASIONALLY (1 - 3 HRS)

        Pulling 0 - 10 lbs: OCCASIONALLY (1 - 3 HRS)

        Pulling 11 - 25 lbs: RARELY (0-1 HRS)

        Pulling 25 - 50 lbs: RARELY (0-1 HRS)

        Pulling 51 - 75 lbs: NEVER

        Pulling over 75 lbs: NEVER

        Pushing 0 - 10 lbs: RARELY (0-1 HRS)

        Pushing 11 - 25 lbs: RARELY (0-1 HRS)

        Pushing 25 - 50 lbs: RARELY (0-1 HRS)

        Pushing 51 - 75 lbs: NEVER

        Pushing over 75 lbs: NEVER

        Reaching (above shoulder level): RARELY (0-1 HRS)

        Reaching (below shoulder level): RARELY (0-1 HRS)

        Repetitive use of hand: CONSTANTLY (6+ HRS)

        Simple Grasping: OCCASIONALLY (1 - 3 HRS)

        Sitting: CONSTANTLY (6+ HRS)

        Standing: OCCASIONALLY (1 - 3 HRS)

        Twisting: RARELY (0-1 HRS)

        Use of Personal Protective Equipment: As established by Department Standards

        Walking: OCCASIONALLY (1 - 3 HRS)

        Working around equipment and machinery: Office equipment

        Ages of Patients Served: N/A

        In the spirit of pay transparency, we are excited to share the base range for this position, exclusive of fringe benefits or potential bonuses.
        19.39 - 27.66
        If you are hired at Family Health Centers of San Diego, your final base salary compensation will be determined based on factors such as geographic location, jurisdictional requirements, skills, education, and/or experience. In addition to these factors - we believe in the importance of pay equity and consider internal equity of our current team members as a part of any final offer. Please keep in mind that the range mentioned above is what we reasonably expect to pay for the role. Hiring at the maximum of the range would not be typical in order to allow for future and continued salary growth. We also offer a generous compensation and benefits package (more information on our benefits offerings is available here: FHCSD Wellness - Employee Hub (

Keywords: Family Health Centers of San Diego, San Diego , Quality of Care Navigator, Other , San Diego, California

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