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About the Role

The Community Health Worker- Navigator is responsible for conducting Health-Related Social Needs (HRSN) Screenings within the Social Care Network (SCN) to identify unmet needs and ensure members are appropriately referred for further support. This role plays a critical role in ensuring timely connection to Enhanced Care Management.

Responsibilities

• Conduct Health-Related Social Needs (HRSN) Screenings.
• Perform accurate data entry in the assigned platform.
• Confirm Medicaid eligibility.
• Obtain informed consent.
• Document Medicaid-billable services.
• Accept referrals and initiate screenings after confirming Medicaid status and SCN eligibility.
• Search for members in the designated platform; create or update member profiles.
• Verify consent status and obtain new consent if required.
• Administer the HRSN Community Health Worker- Navigator, documenting responses accurately.
• Manage sensitive questions with discretion.
• Track and document time spent, participants involved, and any declined screenings.
• Submit completed screenings for review.
• Conduct re-screening only when a major life event has occurred.
• Document reasons for re-screening, date/time, and duration.
• Accept referrals in assigned software system and conduct outreach (3 attempts within 5 business days).
• Engage members, confirm needs, and obtain consent.
• Complete Eligibility Assessment to determine Standard vs. Enhanced Services.
• Connect members to community resources or Enhanced CM agencies.
• Document all steps and close or transition cases as appropriate.
• Submit units for reimbursement per the approved fee schedule.
• Refer members with unmet needs to Enhanced Care Management.
• Document needs and context in the referral description to ensure continuity of care.

Requirements

• High School Diploma or equivalent required or associate’s degree in human services, preferred.
• One (2) year of experience in case management, health care coordination, or community health preferred.
• Bilingual (English/Spanish) strongly preferred.
• Strong organizational, documentation, and data-entry skills with attention to detail.
• Ability to engage with diverse populations professionally and empathetically.
• Ensures proper documentation for Medicaid-billable services.
• Builds rapport, obtains informed consent, and handles sensitive topics with care.
• Works closely with Navigators, Eligibility Specialists, and Enhanced Care Management partners.
• Adheres to HIPAA, agency, and funder compliance requirements.
• Occasional standing, squatting, lifting of up to approximately 10 lbs. and frequent sitting.

Skills

• Health-Related Social Needs (HRSN) Screenings
• Data Entry
• Medicaid Eligibility Verification
• Informed Consent
• Documentation
• Case Management
• Health Care Coordination
• Community Health
• Bilingual (English/Spanish)
• Organizational Skills
• Attention to Detail
• Professional Engagement
• Empathetic Engagement
• HIPAA Compliance

Experience Level

• 1-2 years experience

Education Level

• High School Diploma or equivalent
• Associate's degree in human services preferred