The Care Navigator is a non-clinical member of the SCO Care Team whose role is to build working relationships, solve problems, and support members in receiving needed services in a person-centered approach to care.  The Care Navigator is a liaison between the Member, Care Manager, GSSC and other Interdisciplinary Care Team (ICT) participants to ensure the member’s care is coordinated and issues resolved. He/she is responsible for a caseload of low risk members. Advocates for the member by collaborating with the Care Team, sharing information, working with community-based providers, enhancing benefit coordination, and improving communication to deliver better overall care.

KEY FUNCTIONS/RESPONSIBILITIES: 

• Work in a person-centered, culturally-sensitive team approach to facilitate member’s care in overcoming barriers, negotiating the healthcare system, and accessing appropriate community-based and other services.
• Act as the central communicator and care coordinator between the member and his/her Interdisciplinary Care Team (ICT) to support the member and their Individual Plan of Care (IPC).
• Monitor and communicate with members identified as low risk without services through telephonic assessments, coordinating and facilitating access to services, resolving issues or benefit questions, and transferring to the appropriate Care Manager or other ICT participants as needed.
• Make inbound and outbound calls to follow up with member/caregiver to ensure services are in place according to IPC, provide appointment and preventive care reminders, facilitate timely referrals, obtain and relay requested information, and coordinate among multiple vendors.
• Establish positive relationships with members/caregivers, other care team participants, community providers, and others involved in member care.
• Proactively intervene and work with member/caregiver encountering issues or barriers to care or services.
• Maintain communication to identify members who might be “at risk” and facilitate communication and involvement of appropriate care manager and/or provider.
• Maintain knowledge about resources available to support members and connect members to those services including Long Term Support Services (LTSS).
• Document actions and communication in the Centralized Enrollee Record (CER).
• Participate in ICT meetings.
• Prepare reports as needed.
• Perform tasks and actions to ensure all CMS and State member related regulatory mandates are met.
• Perform other duties as requested.

QUALIFICATIONS:

EXPERIENCE:

• Minimum 2 year experience in a healthcare or social service setting is required
• Experience working with Long Term Support Services a plus
• Experience working with culturally diverse populations

EDUCATION:

• Associate’s degree in Healthcare or business administration, or a related area or equivalent relevant work experience

PREFERRED/DESIRABLE:

• Knowledge of care management software systems, health care databases 
• Bilingual skills, fluency in Spanish

COMPETENCIES, SKILLS, AND ATTRIBUTES:

• Excellent interpersonal, listening, and communication skills
• Ability to establish effective working relationships with Members, professionals on the care team, providers, and others
• Ability to communicate knowledgably about local services, in particular Long Term Support Services, etc.
• Excellent organizational and time management skills
• Ability to work independently and in a team management system
• Sensitivity to low income, ethnic minority community
• Excellent documentation skills
• Intermediate skill level with Microsoft Office products – Outlook, Word, Excel

*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

Required Skills Required Experience