Patient Navigator

We’re unique. You should be, too.

We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Patient Navigator I (Tier
1) is a non-clinical, patient-facing role responsible for the first-touch handling of the tickets across Patient Navigation’s three Phase 1 work streams:
Non-CPL (Coordinated Provider List) /Out-of-Network Requests, Care Plan Non-Adherence, and Voluntary PCP Switches. Operating within a centralized, 100%-recorded and monitored call center model, the Patient Navigator I engages patients directly by phone to understand their request, explain relevant options, and either resolve the ticket directly or route it to the appropriate next step — including escalation to a Tier 2 resource to support when appropriate (Supervisor, Clinical Leadership, or Network Leadership)
This role is the primary voice of this role is for most patient interactions and is expected to combine strong interpersonal and persuasive skills with rigorous documentation discipline, given the compliance-sensitive nature of the function. The Patient Navigator I does not make clinical determinations, does not perform utilization management decisions, and does not apply retention pressure to patients requesting a PCP change — CMS treats PCP selection as a protected member right, and this role is expected to process such requests without friction.
Above all, this role serves to ensure that patients fully understand how Chen Med’s model for simplifying complex care through the development of personalized care plans, using in-house specialty care, and working within our trusted coordinated provider ecosystem delivers more good days.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Fields inbound and outbound tickets across the three in-scope work streams (Non-CPL (Coordinated Provider List)/Out-of-Network Requests, Care Plan Non-Adherence, and Voluntary PCP Switches) via the centralized, 100%-recorded intake queue, sourced from Careline & Field-Initiated Tickets, Patient-Initiated Appeals for Clinical Review, and Non-CPL/Out-of-House Requests channels.
• For Non-CPL/Out-of-Network Requests: engages patients who want to use a provider outside the CPL, explains available in-network/CPL-coordinated options, and encourages use of those options through positive, informative conversation — without denying, authorizing, or influencing any coverage or network-exception determination, which remains the responsibility of formal Utilization Management.
• For Care Plan Non-Adherence: conducts first-touch outreach to patients flagged as unable or unwilling to follow a recommended care plan, using supportive, empathetic communication to understand and address straightforward barriers; escalates any case involving a genuine clinical barrier, safety concern, or need for informed-refusal documentation to a Tier 2 RN/Licensed Social Worker rather than attempting to resolve it directly.
• For Voluntary PCP Switches: processes patient requests to change their assigned PCP promptly, completely, and without applying any retention pressure or persuasion; ensures attribution changes, record transfers, and required documentation are initiated accurately and within required time frames.
• Documents every case in the centralized case-management system to the standard required for CMS delegation-oversight audits, including outreach attempts, call content, outcome, and any escalation — documentation quality is treated as a core job function, not an afterthought.
• Recognizes when a ticket…