Care Navigator

Company Mission

Duo Health is a new type of medical group designed around the needs of patients with chronic kidney disease and their physicians. Our unique Health Mobilization™ platform partners multidisciplinary care teams with community nephrologists and activates all the other clinicians, facilities and community organizations necessary to treat the whole patient on their own terms. Our team is comprised of leaders in value-based health care, technology and behavioral science who share a vision for advancing health equity one relationship at a time.

Our interprofessional care teams, which include physicians, nurses, social workers, and patient navigators, provide high-touch and comprehensive care to a small panel of patients. Team collaboration is essential to our intensive, psycho-social model of care which includes assessment, medication management, social management, and behavioral health management. Duo Health is dedicated to ensuring our staff reflects the diversity of our patient population and applicants whose work demonstrates a commitment to issues of diversity are encouraged to apply.

Job Description

The Navigator is an ideal position for a proactive, self-motivated, positive individual who will work closely with the interprofessional care team to coordinate patient care and improve patient outcomes. The Navigator will act as the day-to-day primary engagement point for patients and will focus on building and maintaining relationships with patients, community organizations, and care team members. The Navigator will help patients utilize available resources and must be able to solve problems, troubleshoot, and handle a variety of daily activities including appointment scheduling and patient education.

Work location expected to be a combination of on-location (office site, dialysis clinic, patient in-home visits) and remote.

Duties and Responsibilities

• Collaborate with the core functional care team to provide psychosocial interventions and case management services to a small panel of patients.
• Interact with patients in the home, via teleconference, or via telephone as appropriate.
• Provide exceptional customer service to patients and internal team members and resolve patient requests and concerns in a timely and accurate manner.
• Maintain clear channels of communication between care team members, patients, caregivers, and health professionals from other organizations.
• Assist with processing physician orders in the electronic medical record (EMR).
• Assist with scheduling patient visits.
• Answer patient telephone calls, troubleshoot issues, and involve care team members as necessary.
• Be available for after-hours telephone support as needed.
• Assist with development and implementation of comprehensive care plans for the patient panel.
• Develop and expand knowledge of available community resources, including services and programs provided, and assist patients with navigating the procedures required to access such resources.
• Participate in and support the care processes of the interprofessional team, including gathering patient information and educating patients on the proper use of equipment and resources.
• Maintain confidentiality regarding all patient sensitive information.
• Document all encounters accurately and in a timely manner.
• Support company efforts of continuous quality improvement.
• Adhere to all company policies and procedures.

Requirements

Working for Duo