Patient Navigator

Job Description Reporting to the Director of Navigation Services and Patient Experience, the Patient Navigator delivers comprehensive care coordination, insurance enrollment support, financial advocacy, and medication access assistance for individuals seeking services such as medical abortion (MAB), gender-affirming hormone therapy (GAHT), PrEP/PEP, and a full range of reproductive and sexual health care. This position guides patients through complex healthcare systems, including NJ FamilyCare (Medicaid), Presumptive Eligibility, and the Health Insurance Marketplace, to ensure timely access to care. The Patient Navigator also supports prior authorization and appeal processes, facilitates medication access, and connects patients with financial aid and community resources.

Essential Functions 1. Guide patients through enrollment in public and private insurance programs, including NJ FamilyCare (Medicaid), Presumptive Eligibility, and Qualified Health Plans (QHPs) via NJ GetCovered, ensuring applications are accurate, thorough, and submitted on time.

2. Serve as a PE Provider and maintain certification as required.

3. Review and verify all applications and supporting documents for accuracy and completeness.

4. Assist patients with renewals, eligibility updates, and submission of required verifications.

5. Educate patients about insurance benefits, coverage limits, provider networks, plan tiers, and out-of-pocket costs to empower informed decision-making.

6. Serve as case manager for Presumptive Eligibility patients, conducting follow-ups to ensure continuity of coverage.

7. Provide navigation support to patients seeking medical abortion (MAB), gender-affirming hormone therapy (GAHT), PrEP/PEP, and comprehensive reproductive and sexual health services.

8. Coordinate appointments, referrals, laboratory services, transportation (such as Uber Health), and follow-up care as needed for patients.

9. Work collaboratively with clinical teams to remove barriers to care and ensure seamless service continuity.

10. Provide education regarding program eligibility, funding sources, and service coverage.

11. Ensures adherence with PPMNJ’s "Privacy Guidelines," HIPAA compliance program, and PPFA’s MS&Gs, where applicable.

12. Initiate, track, and follow up on prior authorizations for medications and services.

13. Address insurance denials by reviewing cases, assisting with appeals, and submitting required documentation.

14. Coordinate with pharmacies, healthcare providers, and insurance carriers to ensure timely access to prescribed medications for patients.

15. Assist patients in accessing manufacturer assistance programs, co-pay cards, grant funding, and other financial assistance programs.

16. Track and document outcomes related to medication access and resolution of insurance issues.

17. Collect program data as needed.

18. Assess patient eligibility for both internal and external funding opportunities.

19. Provide financial counseling regarding insurance coverage, anticipated out-of-pocket costs, and available payment options.

20. Connect patients to community-based resources that address social determinants of health, including housing, transportation, and food access.

21. Accurately document all patient interactions, applications, case notes, and follow-up activities in the electronic health record (EHR) system (e.g., EPIC) and other platforms such as CoverMyMeds.

22. Maintain compliance with federal, state, and organizational guidelines related to confidentiality, HIPAA, and funding requirements.

23. Consistently meet productivity and performance benchmarks for application processing, follow-up, and patient outcomes.

24. Conduct outreach activities to promote enrollment services and increase program awareness, as assigned.

25. Maintain and update referral resources and community partnership lists.

26. Collaborate with education, advocacy, clinical, and administrative teams to support patient-centered initiatives and foster community engagement.

27. Actively participate in team meetings, quality improvement projects, and ongoing professional development and training

Benefits Benefits:

 

• 401(k)

• 401(k) matching

• Dental insurance

• Flexible spending account

• Health insurance

• Life insurance

• Paid time off

• Professional development assistance

• Referral program

• Vision insurance

Education & Experience& Language -Associates Degree (Preferred)

 

-1 year Experience of Patient Navigation

 

-Spanish (Preferred)