Population Health Navigator- Accountable Care Organization-Days-MFT

The Population Health Navigator is responsible for promoting effective partnerships between patients/families and the health care team to facilitate care for patients and effectively manage the care transitions to facilitate a �shared goal model�. The Navigator will partner with the provider care team to complete annual wellness visits, assist to reduce the severity of chronic disease and prevent avoidable acute illnesses. The Navigator will provide effective clinical health coaching to assist patients with self-management of their chronic disease and lifestyle changes to mitigate health risk using care coordination activities and analytics in the ambulatory setting.