Care Navigator

Position purpose

The Care Navigator is a contracted member of the Navigate Care team responsible for carrying out assigned care-navigation and care-coordination activities for Medicare patients experiencing chronic illness, serious illness, healthcare access barriers, or health-related social needs.

The Care Navigator helps ensure that important healthcare activities do not become lost, delayed, or unresolved between patients, caregivers, practitioners, healthcare organizations, pharmacies, and community resources.

Care Navigators perform assigned activities consistent with the patient's established care plan, Navigate Care policies and procedures, applicable Medicare program requirements, and the individual's qualifications and permitted scope of practice.

The Care Navigator does not independently diagnose conditions, make clinical decisions, establish or modify a clinical plan of care, or perform activities requiring professional licensure unless appropriately licensed and specifically authorized to perform those services.

Care-team relationships

The Care Navigator coordinates assigned activities with the designated Navigate Care Manager and other authorized members of the patient's care team.

Depending on the program and the patient's needs, the Care Navigator may communicate and coordinate with patients, caregivers, physicians and other practitioners, licensed healthcare professionals, healthcare organizations, pharmacies, post-acute providers, community organizations, transportation providers, benefit and social-service organizations, and other authorized persons involved in addressing an identified patient need.

Care Navigators do not independently direct the patient's clinical care.

Patient and caregiver navigation

• Conduct scheduled outreach to patients and caregivers
• Establish and maintain professional, supportive relationships with patients and caregivers
• Review assigned care-navigation activities and identified patient needs
• Help patients understand nonclinical next steps identified by the care team
• Obtain information needed to complete assigned activities
• Assist patients and caregivers with appointments, referrals, resources, and follow-up
• Identify barriers interfering with completion of assigned activities
• Provide appropriate follow-up
• Communicate outstanding needs and barriers to the appropriate member of the care team
• Perform assigned activities in accordance with Navigate Care's Closed-Loop Care Navigation Policy

Appointment, referral, and provider coordination

• Assist with scheduling primary care and specialty appointments
• Communicate and confirm appointment information
• Assist with transportation coordination
• Contact practitioner offices and healthcare organizations
• Track referrals and appointment requests
• Follow up on the status of referrals and appointments
• Identify barriers to completion
• Communicate unresolved issues to the appropriate team member
• Document coordination activities and outcomes

Medical-record coordination

• Collect information regarding healthcare providers and organizations
• Prepare and transmit authorized medical-record requests
• Follow up on outstanding record requests
• Receive records through approved systems
• Upload, organize, and appropriately label received documentation
• Route relevant records to the designated Care Manager or authorized practitioner
• Track outstanding documentation needs
• Document record-related activities

The Care Navigator does not independently interpret clinical findings in medical records unless separately qualified and authorized to do so.

Medication-access and pharmacy coordination

Within the permitted scope of the assigned role, the Care Navigator may:

• Contact pharmacies regarding medication availability or prescription status
• Identify medication-access barriers
• Assist with nonclinical medication-access issues
• Follow up on availability, delivery, affordability, or other access concerns
• Facilitate communication between the patient, pharmacy, and care team
• Route clinical medication questions or concerns to the appropriate licensed professional

Care Navigators do not independently recommend medications or medication changes, provide medication counseling that requires professional licensure, or resolve clinical medication questions.

Health-related social needs and community resources

The Care Navigator may assist patients with health-related social needs affecting their ability to access or follow through with healthcare, including transportation, food access, medication affordability, financial barriers, benefits and coverage, housing, utilities, caregiver support, social isolation, community resources, language or communication barriers, and health literacy.

• Administer approved screening or information-gathering tools
• Gather information regarding patient needs and barriers
• Provide information regarding available resources
• Assist with approved applications and forms
• Facilitate referrals
• Follow up on applications, referrals, and resources
• Communicate unresolved needs to the appropriate care-team member

Screening findings that require clinical interpretation must be routed to an appropriately qualified professional. Care Navigators do not guarantee eligibility for, approval of, or availability of community benefits, programs, or services.

Care-plan activities

The Care Navigator is responsible for completing care-navigation activities assigned through the patient's established care plan or Navigate Care workflow.

Activities may include patient and caregiver outreach; follow-up communication; appointment and referral coordination; provider and pharmacy communication; medical-record acquisition; community-resource coordination; transportation coordination; forms and applications; authorized transmission of information; information gathering; tracking assigned activities; documentation; and appropriate referral or escalation of unresolved concerns.

The Care Navigator must perform only those activities appropriate to the individual's qualifications, assigned responsibilities, applicable program requirements, and permitted scope.

Documentation and timekeeping

Every patient-related activity must be documented in the Navigate Care platform or other Navigate Care-authorized systems. Documentation must be accurate, factual, objective, patient-specific, timely, complete, and consistent with Navigate Care requirements.

• Identify the activity performed, date and time, and the person or organization contacted
• Record information obtained or communicated, and the patient or caregiver response
• Record the outcome, remaining barriers, required follow-up, and who owns the next action
• Record referrals or escalations made, and the final activity status
• Accurately track applicable care-management time using the approved timekeeping process when required

Time documentation must reflect actual qualifying activities performed. Care Navigators may not create, inflate, duplicate, estimate, or otherwise inaccurately report patient-service time.

Clinical and professional scope

Care Navigators provide navigation, coordination, information gathering, communication, follow-through, and resource assistance.

Unless separately qualified, licensed, and specifically authorized, a Care Navigator does not independently:

• Diagnose a medical, psychiatric, behavioral, or other health condition
• Perform a clinical assessment requiring professional judgment
• Determine medical necessity
• Develop or modify a clinical treatment plan or plan of care
• Provide independent clinical triage
• Interpret laboratory, diagnostic, or other clinical findings
• Recommend medical treatment or medication changes
• Provide medical, nursing, psychological, clinical social-work, or other licensed professional advice or services
• Make decisions reserved for a licensed healthcare professional
• Perform an activity prohibited by applicable state or federal law

Care Navigators must recognize and appropriately refer concerns that require clinical judgment, urgent intervention, or supervisory assistance, in accordance with Navigate Care's Patient and Clinical Escalation Policy. When uncertain whether an activity is within role, seek guidance before proceeding independently.

Privacy, confidentiality, and information security

• Comply with applicable HIPAA privacy and security requirements
• Follow Navigate Care privacy, confidentiality, cybersecurity, and information-security policies
• Access only information necessary to perform assigned responsibilities
• Use only approved communication and documentation systems
• Verify identity and authority before disclosing protected information
• Maintain appropriate safeguards when working remotely
• Protect passwords and access credentials
• Prevent unauthorized access to protected health information
• Avoid storing protected information on unauthorized devices or applications
• Immediately report suspected privacy or security incidents
• Complete required privacy and security training

Technology and equipment

As a condition of engagement, the Care Navigator must provide and maintain a personal computer suitable for performing assigned Navigate Care responsibilities.

• Reliable internet connectivity
• A functioning microphone
• A functioning camera
• Support for Navigate Care-approved communication, documentation, workflow, and meeting platforms
• Support for video-based patient meetings and engagement
• Support for staff, care-team, training, and other required meetings
• Meet Navigate Care privacy, security, and technical specifications

You are responsible for keeping the equipment in working condition and for maintaining a work environment that supports professional, confidential communications. The camera and microphone must be available when required. Protected health information may not be stored locally or transmitted through unauthorized applications, systems, or devices.

Use of technology and AI-assisted tools

Care Navigators may use Navigate Care-approved technology and AI-assisted tools only in accordance with organizational requirements governing privacy, security, appropriate use, human review, documentation accuracy, and professional scope.

AI-assisted tools do not replace the Care Navigator's responsibility to verify information, accurately document services, comply with established protocols, and refer matters requiring professional judgment.

Minimum qualifications

• Effective verbal and written communication in English, and the use of translation assistance
• Strong emotional intelligence — self-awareness, empathy, emotional regulation, sound interpersonal judgment, professionalism, and the ability to communicate well in stressful, sensitive, or emotionally difficult situations
• Professional communication with patients, caregivers, healthcare professionals, organizations, pharmacies, and community resources
• Strong organizational, prioritization, and follow-up skills
• Persistence while maintaining professional judgment and appropriate boundaries
• Ability to manage multiple assigned patients and activities
• Ability to follow established policies, procedures, workflows, and protocols
• Competency with electronic communication, documentation, and workflow-management systems
• Accurate and timely documentation
• Protection of confidential patient information
• Ability to work independently within defined responsibilities
• Ability to recognize when assistance or escalation is required
• Completion of required Navigate Care orientation, training, and competency validation
• Willingness and ability to accept and perform a minimum of ten (10) hours of assigned work per week when work is available and assigned, with enough availability to complete accepted activities, follow-up, and documentation on time
• Any additional qualifications required for the applicable Medicare program, patient population, state, or assigned activity

Preferred qualifications

Licensure as a social worker in the state in which assigned patients reside is preferred but is not required.

Additional preferred qualifications include education, training, or experience in social work, care coordination, patient navigation, healthcare, aging services, community health, social services, Medicare populations, chronic or serious illness, home health, hospice, hospital discharge coordination, physician practices, pharmacy coordination, benefits navigation, or health-related social-needs programs.

Possession of a professional license does not independently authorize a Care Navigator to provide licensed clinical or professional services on behalf of Navigate Care. Any professional service requiring licensure must be specifically authorized, appropriately assigned, within the individual's legal scope of practice, and performed in accordance with applicable supervision and program requirements.

Assignment of responsibilities

Patient assignments and activities may vary based on patient needs; care-plan requirements; education and experience; demonstrated competency; professional credentials or licensure; state law and scope-of-practice requirements; Medicare or payer requirements; supervision requirements; Navigate Care policies; and the complexity or risk of the activity.

Navigate Care may limit or modify assigned activities based on qualifications, competency, licensure, applicable program requirements, or identified risk.

Performance expectations

Successful Care Navigators demonstrate accountability; persistence; strong emotional intelligence; professional communication; organization; timely follow-through; accurate documentation; appropriate use of established referral and escalation processes; compliance with closed-loop navigation requirements; respect for professional scope boundaries; protection of patient privacy; and commitment to resolving assigned patient needs appropriately.

The arrangement