Social Care Navigator
Social Care Navigator
Posted on :
14-07-2025
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1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
14-07-2025
Job Description
Description
Location: Middletown NY
Hours: M-F
Rate of Pay: $21.63
OVERVIEW OF PRIMARY RESPONSIBILITES:
The Community Health Worker (CHW) Social Care Network Specialist plays a key role in advancing the New York State 1115 Medicaid waivers focus on addressing health-related social needs (HRSN). This role emphasizes conducting comprehensive HRSN assessments connecting individuals and families to community resources and coordinating services through Social Care Networks (SCNs). The CHW acts as a trusted bridge between healthcare systems social care providers and the communities served.
PRIMARY FUNCTIONS:
Health-Related Social Needs (HRSN) Assessments:
- Conduct thorough HRSN assessments to identify barriers to health such as housing instability food insecurity transportation challenges and lack of access to social services.
- Use standardized tools and evidence-based practices to evaluate client needs and strengths.
- Prioritize outreach to Medicaid members with complex needs or at high risk for poor health outcomes.
Client Support and Navigation:
- Develop personalized action plans based on HRSN assessment findings.
- Provide direct support to clients in accessing community resources and overcoming systemic barriers.
- Offer culturally competent education on available services and empower clients to advocate for their needs.
Referral Coordination within Social Care Networks (SCNs):
- Leverage SCN platforms (Unite Us) to initiate and track referrals.
- Work closely with SCN partners to ensure timely and effective service delivery.
- Monitor and document referral outcomes ensuring clients needs are adequately addressed.
Collaboration with Healthcare Providers and Community Stakeholders:
- Partner with managed care organizations (MCOs) healthcare providers and community-based organizations (CBOs) to integrate social and healthcare services.
- Facilitate communication between clients and medical providers ensuring HRSN are addressed alongside clinical care.
- Participate in care team meetings to share assessment findings and collaborate on care coordination.
- Field-based role involving home visits community outreach and coordination with local agencies.
Data Collection and Reporting:
- Maintain accurate and detailed records of HRSN assessments client interactions and outcomes.
- Analyze data to identify trends service gaps and areas for improvement in addressing HRSN.
- Contribute to the evaluation of the SCNs impact on health outcomes and the 1115 waiver goals.
Community Engagement and Capacity Building:
- Build partnerships with community leaders and organizations to expand access to resources.
- Educate stakeholders about the importance of HRSN and the integration of social and healthcare services.
- Assist in the development of educational materials to support client understanding of available services.
ADDITIONAL FUNCTIONAL / ORGANIZATIONAL SUPPORT:
N/A
QUALIFICATIONS AND ATTRIBUTES:
- Strong organization skills with accurate attention to detail
- Excellent communication skills and the ability to multi- task
- Knowledgeable and skilled in understanding and educating others on healthcare healthcare systems healthcare reform pathways to care and communication with community providers.
- Experience conducting assessments especially related to HRSN in healthcare or social service settings.
- Familiarity with Medicaid programs 1115 waiver initiatives and SDOH frameworks.
- Excellent interpersonal communication and problem-solving skills.
- Proficiency with electronic data systems and referral platforms.
- Excellent verbal written and presentation skills.
- Bilingual or multilingual abilities preferred.
EDUCATION AND EXPERIENCE:
- High school diploma or equivalent required; associate or bachelors degree in social work public health or a related field preferred.
- Completion of a recognized Community Health Worker training program preferred.
PHYSICAL CHARACTERISTICS:
- Must be capable to sit or stand in front of a computer for long-periods of time
- Able to work in open space floor plan
- Must be capable to move throughout work day and work with people in the community (people we serve and providers)
- Work alongside co-workers within 3 feet
- Occasional lifting of > 25 pounds
EEO
Employment Type
Full-Time
Key Skills
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