Patient Navigator, MSW, BSW or CHW
On-site · Las Cruces, New Mexico, United States
Job Summary
The Sierra Cares Navigator coordinates referrals and smooths transitions from hospital to home health, hospice, or palliative care, acting as a liaison between hospitals and Sierra Healthcare to improve patient outcomes. Responsibilities include maintaining a real-time census of referrals, tracking referral flow from intake to start of care, ensuring documentation accuracy for internal reporting, coordinating centralized intake to support rapid service initiation (often within 24 hours), verifying eligibility and collecting necessary documentation, serving as a point of contact for patients and families, promoting the Sierra Cares program through rounds and education sessions, tracking program metrics (patients served, readmissions, satisfaction, timeliness), identifying barriers and recommending workflow improvements, and providing patient education and connecting patients with community resources.
Required Qualifications
- Experience in healthcare case management or care coordination.
- Experience with hospital discharge planning, home health, hospice, or post-acute care preferred.
- Strong communication and collaboration skills with interdisciplinary clinical teams.
- Ability to manage time-sensitive referrals and multiple priorities.
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