Role Overview:
The Community Health Navigator focuses on engaging members through outreach and in-person visits, identifying and addressing Social Determinants of Health (SDOH) needs, improving access to healthcare services, and supporting members in navigating available benefits, community resources, and promoting preventive care, reducing barriers to care, and connecting members to programs that support their overall health and well-being.
Work Arrangement:
Remote/field-based – Associate must be able to travel to the Pennsylvania counties served.
Approximately 95% travel required throughout Berks, Lehigh, Lancaster, Delaware, and Chester counties to meet with members in hospitals, homes, or community locations.
Responsibilities:
Community Education
Develops and maintains relationships with new and established community organizations via phone, mail, e-mail and personal visits.
Collaborates with internal departments and external agencies to obtain data that is pertinent to the overall success of health education/promotion programs.
Provides education to members and member representatives regarding nursing facility transitions and available benefits.
Member Outreach:
Establishes connection for Long-Term Services and Supports members, identified as unable to reach through unannounced home visits and outreach calls.
Exercises judgment and discretion in the coordination of care by handling basic care follow up tasks and collaborating with AmeriHealth Caritas case management teams, community based health care providers, and other organizations.
Performs outreach calls to members to identify barriers and/or unmet needs.
Informs members of the required actions to fulfill HEDIS, EPSDT, and Plan requirements and other referred outreach, through phone calls or home visits, and encourages them to comply.
Assists in addressing members’ barriers to care and to encourage/foster relationships with their medical/dental providers (medical/dental homes.
Coordinates with Primary Care Physicians for the completion of Comprehensive Medical Reports needed for annual redeterminations.
Assists members with obtaining community resources and DME.
Performs in-facility assessments on Long-Term Services and Supports members with an interest in transitioning out of the nursing facility.
Assists in the transition of members from the nursing facility to community by assisting to obtain birth certificates, identification cards, social security cards and award letters, shopping for approved household items and sets up those items.
Performs initial telephonic outreach to new members and acts as a back up to the personal care coordinators.
Performs tasks as assigned by Long-Term Services and Supports management team to support members.
Documents contact with members within the case management system.
Education/Experience:
Associate’s Degree in Health Care, Human Services, or a related field or equivalent work experience (Behavioral Health or Substance Abuse) preferred.
Bachelor’s Degree preferred.
Minimum of 2 (two) years of health care in an office/clinic/hospital setting or human services experience.
Licensure:
Valid driver's license, car insurance, and reliable transportation required.
Other Skills:
Community based care experience preferred.
Knowledge of Medicaid requirements and plan, policies and procedures.
Knowledge of managed care.
95% of time will be spent traveling.
Physical ability to perform tasks that may require prolonged standing, sitting, and other activities necessary to perform job duties such as lifting premium giveaways, educational materials, and household items for set-up.
Knowledge of and experience working with vulnerable populations preferred.
Knowledge of and experience with substance use disorder and behavioral health preferred.
Understand how to collaborate with a variety of different people and roles.
Show strong growth mindset and are able to learn from setbacks.
Stay focused and organized while juggling multiple…