Care Navigator

The Care Navigator serves as a guide and advocate for members helping them navigate healthcare and social service systems to improve health outcomes and overall quality of life. Through member engagement education coordination and barrier reduction this role supports members in accessing services understanding available care options and connecting to community resources that address medical behavioral health and social needs. The Care Navigator alsofacilitatescommunication among providers care teams and service partners to support continuity of care and reduce barriersimpactingmember wellbeing.

This is a non-clinical role focused on member engagement access and navigation support. The Care Navigatoroperateswithin standardized tools protocols and established workflows and does not perform clinical assessments diagnoses or care plan development. All clinical concerns higher-acuity needs and issues requiring clinical judgment are escalated to Care Coordinators or licensed clinical staffin accordance withestablished procedures.

• Engage membersidentifiedthrough data analysis referrals provider recommendations or community sources with a focus on low-risk or rising-risk membersappropriate fornavigation-level support.

• Conduct standardized screenings using approved assessment tools and escalate findings requiring clinical interpretation to licensed care team members.

• Provide culturally responsive health education supportive guidance and resource navigation to promote healthy behaviors and self-management.

• Support members with healthcare access needs including appointment scheduling benefit understanding and connection to appropriate services.

• Monitor andidentifychanges in member condition risk status barriers to care or unmet needs and escalate concerns to Care Coordinators or licensed clinical staff according to established workflows.

• Conduct community outreach activities including home visits transportation coordination and connection to medical behavioral health substance use and social service resources.

• Provide telephonic and face-to-face follow-up with members and care team partners to support care plan activities appointment adherence and medication coordination.

• Collaborate with care managers and interdisciplinary teams to coordinate referrals to community-based organizations and network providers addressing identified member needs.

• Communicatetimelyupdatesregardingmember progress risks barriers and unmet needs tocaremanagers providers and care team partners.

• Maintainaccuratetimely and audit-ready documentation in compliance with organizational policies contractual requirements and regulatory standards.

• Travel throughout the service area as needed to support field-based member engagement activities including home and community visits with fieldwork constituting at least twenty-five percent of assigned duties.

• Perform other duties as assigned; responsibilities may bemodifiedbased on organizational needs.

Performance Expectations

• Member outreach and engagement targets

• Appointment scheduling completion rates

• Resource linkage completion rates

• Timeliness and accuracy of documentation

• Effective escalation of higher-risk or clinical needs
  

• Working with a variety of personalities maintaining a consistent and fair communication style.
• Satisfying the needs of a fast-paced and challenging company.

• Medical Assistant Certified Clinical Medical Assistant or OHA-recognized Traditional Health Worker (THW) certification such as Community Health Worker (CHW) Peer Support Specialist or Personal Health Navigator (PHN).
  Three (3) years of experience in a healthcare or community health setting.
  Mustpossessa valid drivers license andmaintaincurrent automobile insurancein accordance withminimum state requirements.

• Ability to recognize potential barriers unmet needs or changes in member status and appropriately escalate concerns to clinical staff.
  No suspension exclusion or debarment from participation in federal healthcare programs (e.g. Medicare or Medicaid).

• Proficiencyin computerized systems for data entry documentation and information retrieval.

• Ability toidentifymember barriers and support resolution throughappropriate referraland escalation processes.

• Working knowledge of community resources providers and healthcare facilities that support member needs.

• Demonstrated commitment to confidentiality privacy and protection of health informationin accordance withorganizational and regulatory requirements.

• Associate degree in healthcare social services public health ora relatedfield preferred.

• Experience collaborating with providers and interdisciplinary healthcare teams.

• Understanding ofhealthcare benefits covered services and community-based support options.

• Knowledge of care navigation practices and community-based member support services.

• Ability toidentifybarriers to successful care coordination andassistin developingappropriate solutions.

• Bilingual or multilingual communication skillspreferred.

• Salary is dependent on skills experience and education
• Generous benefits package including vacation PTO sick leave federal holidays and birthday leave
• Medical dental and vision insurance
• 401(k) with company match (fully vested immediately)
• Company-sponsored life insurance and additional benefits
• Fitness reimbursement program
• Tuition reimbursement and more