Patient Care Navigator II

The Patient Care Navigator II (PCN II) is the initial point of contact for the Enhanced Care Management (ECM) team, completing outreach in the community, at community agencies, hospitals as well as phone based outreach for members referred to the program. This role leads initial screening, eligibility verification and enrollment for the program. In addition to conducting outreach and enrollment, the Patient Care Navigator II orients and onboards new Patient Care Navigators and takes a lead role in organizing community outreach, building relationships with referral partners, and raising awareness of ECM in the community. Patient Care Navigators do not carry a caseload or provide ongoing care coordination; once a member enrolls, the Navigator completes a warm handoff to the assigned Lead Care Manager. 

FLSA Status: Non-Exempt

Salary Range: $23.00 - $27.00 per hour

Reports To: ECM Program Manager/ Director 

Direct Reports: None

Location: Los Angeles,  CA, San Pedro, CA, Long Beach, CA, Carson, CA, Southbay Area

Travel: 80%

Work Type: Regular

Schedule: Full Time & Part Time 

Position Description: 

Patient outreach and engagement 

• Conduct timely telephonic outreach to members referred or authorized for ECM by health plans, providers, hospitals, and community partners, using approved outreach scripts and multiple contact methods (phone, text, mail, and in person)
• Conduct in-person outreach in the community, including at clinics, hospitals, shelters, community agencies, and members’ homes, to locate and engage members who are difficult to reach by phone
• Explain ECM services and benefits in plain language, answer questions, and address member hesitancy or concerns in a culturally and linguistically appropriate, trauma-informed manner
• Utilize motivational interviewing to engage members and support their decision to enroll
• Vary the time, day, location, and method of outreach attempts, and complete follow-up on unsuccessful contacts in accordance with program outreach standards and timelines
• Serve as a resource for complex or hard-to-reach outreach, including members experiencing homelessness or with significant behavioral health or substance use needs

Screening, Eligibility & Enrollment 

• Complete initial screening to determine whether members meet ECM eligibility criteria and Populations of Focus
• Verify Medi-Cal eligibility, health plan assignment, and ECM authorization status using health plan portals and program tools
• Obtain member consent and complete enrollment forms and required intake documentation accurately and on time
• Track each member’s status through the outreach and enrollment process (e.g., referred, contacted, enrolled, declined, unable to reach) and follow up on pending enrollments
• Connect members to community resources and social services, including housing, food, transportation, and other immediate needs identified during outreach, and escalate urgent needs or safety concerns to the ECM care team per protocol

Community Outreach & Partnership Development 

• Plan, organize, and coordinate community outreach activities, including outreach schedules, partner site visits, health fairs, and community events
• Identify, establish, and maintain relationships with referral partners, including hospitals, clinics, primary care providers, shelters, housing and homeless service agencies, county agencies, and community-based organizations
• Raise awareness of ECM in the community by presenting to community partners and provider staff on ECM eligibility, benefits, and referral pathways
• Serve as the point of contact for assigned community partners and referral sources, responding to referral questions and resolving referral issues
• Track outreach activity, referral sources, and enrollment trends, and recommend strategies to strengthen referral pipelines and enrollment outcomes
• Maintain a current inventory of community resources and partner contacts for use by the outreach team

Orientation, Onboarding & Peer Support 

• Orient and onboard new Patient Care Navigators, including shadowing, field ride-alongs, and review of outreach scripts, eligibility criteria, workflows, and documentation standards
• Serve as a peer resource and subject matter expert on ECM eligibility, outreach best practices, and enrollment workflows
• Review new Navigators’ documentation for completeness during onboarding and share observations with the ECM Program Manager
• Help update outreach scripts, job aids, and training materials

Team Collaboration & Warm Handoff 

• Complete a warm handoff of each newly enrolled member to the assigned Lead Care Manager, ensuring enrollment information is complete and the member knows what to expect next
• Assign members to appropriate Lead Care Managers based on risk category and available clinical data, in coordination with the ECM Program Manager
• Collaborate with RNCMs, LVNs, BHCMs, CHWs, and other care team members regarding referrals, enrollment status, and the transition of newly enrolled members
• Communicate regularly with the ECM Program Manager regarding referral volume, enrollment status, and barriers to outreach

Program Operations & Documentation 

• Maintain timely, accurate documentation in the ECM care management platform in compliance with program requirements, including all outreach attempts, screenings, consents, and enrollment activities
• Meet established outreach productivity and enrollment targets
• Protect member privacy and maintain confidentiality in accordance with HIPAA and organizational policies
• Participate in quality improvement initiatives to strengthen outreach strategies and enrollment outcomes

Additional Responsibilities 

• Attend meetings with providers, health plans, community partners, and internal stakeholders, and represent the ECM program at community and partner meetings
• Provide coverage for outreach and enrollment activities across the team as needed
• Complete additional tasks and projects assigned to support ECM program goals

Qualifications: 

• High school diploma or equivalent required; Associate’s or bachelor’s degree in health administration, Public Health, Social Work, Sociology, Psychology, or related field preferred
• Minimum one (1) year, preferably two (2) years, of experience in community outreach and enrollment, care coordination, community health work, case management, or social services
• Demonstrated success meeting outreach or enrollment targets
• Experience working with high-risk or vulnerable populations
• Strong interpersonal, organizational, and communication skills, including public speaking and presenting to community groups and partners
• Demonstrated ability to build and maintain relationships with community partners and referral sources
• Ability to train, mentor, and support peers
• Ability to manage a high volume of outreach activity and prioritize multiple tasks in a fast-paced environment
• Comfortable with field-based, community, and home visits
• Proficiency with electronic health records and care management platforms
• Reliable transportation with active insurance coverage and a valid California driver’s license
• Ability to work occasional evenings or weekends for community events

Preferred Qualifications 

• Experience working within CalAIM, ECM, managed care, or Medicaid programs
• Experience training, onboarding, or mentoring staff
• Experience planning community outreach events or presentations
• Knowledge of community-based resources and social service systems, including Los Angeles County referral networks
• Community Health Worker (CHW) certificate or training
• Lived experience in, or familiarity with, the communities and populations served
• Bilingual abilities preferred

Benefits: 

As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities, and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/ 

About COPE Health Solutions
COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit https://copehealthsolutions.com/about-us/ 

About Enhanced Care Management
Enhanced Care Management (ECM) supports eligible Medi-Cal members with complex medical, behavioral and health-related social needs through comprehensive, person-centered coordination. Working across health care and community settings, multidisciplinary care teams—including care managers and community health workers—engage members, develop individualized care plans, connect individuals to appropriate services and coordinate with providers and community partners. The program seeks to improve access, continuity and health outcomes while addressing barriers that contribute to avoidable utilization.

To Apply:
To apply for this position or for more information about COPE Health Solutions, visit us at https://copehealthsolutions.com/careers/open-positions/