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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 requires accurate data entry, confirmation of Medicaid eligibility, obtaining informed consent, and proper documentation for Medicaid-billable services, playing 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 from members.
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, reading questions aloud and documenting responses accurately.
Manage sensitive questions with discretion, documenting appropriate responses.
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) years 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 Confirmation
Informed Consent
Documentation
Case Management
Health Care Coordination
Community Health
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)