Community Care Navigator at St. Josephs Candler – Savannah, Georgia

The Community Care Navigator serves as a resource, supporter, encourager and problem solver for SSI Medicare patients with previous admissions to St. Joseph’s/Candler. The primary objective of the Navigator is to assist this patient demographic with establishing care with SJ/C primary care providers and specialty services, while helping navigate additional hospital admissions and post-discharge follow-up care. The Navigator keeps abreast of various services available to patients, connecting patients to established centers and organizations in the community that provide appropriate assistance. The Navigator connects with patients via telephone each month to assess current needs and evaluates the options and services required to meet an individual’s medical and psychosocial needs, The Navigator must have clear written and verbal communication skills and maintain compliance with all laws and regulations.

National Certification in Case Management - Preferred

Assists SSI Medicare patients with establishing a medical home with a primary care physician if needed and other specialty services.

Assists with barriers to care including connecting patients with community services for medical transportation, durable medical equipment, medications and other health services as needed.

Provides a pathway to simpler hospital admission, when appropriate, by coordinating with various departments, providers, and constituents.

Works to identify and connect monthly with SSI Medicare patients within the specified demographic and establishes trust as a knowledgeable resource in navigating various community health services, St. Joseph’s/Candler programs, and referral networks within the greater Savannah area.

Collaborates with other SJ/C initiatives in support of this patient population, including the African American Resource Center, St. Mary’s Community and Health Center and other outreach programs.