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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. The Community Health Worker- Navigator is often the first point of contact for members and plays a critical role in ensuring timely connection to Enhanced Care Management.
Responsibilities
- Conduct Health-Related Social Needs (HRSN) Screenings to identify unmet needs and ensure members are appropriately referred for further support.
- Perform accurate data entry in the assigned platform.
- Confirm Medicaid eligibility.
- Obtain informed consent from members.
- Properly document services for Medicaid billing.
- Accept referrals and initiate screenings after confirming Medicaid status and SCN eligibility.
- Search for members in the designated platform and 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 responses appropriately.
- Track and document time spent, participants involved, and any declined screenings.
- Submit completed screenings in the designated platform 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 the 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 using the Assigned software system referral process.
- Document needs and context in the referral description to ensure continuity of care.
Requirements
- High School Diploma or equivalent required.
- 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 Confirmation
- Informed Consent
- Medicaid-billable Services Documentation
- Case Management
- Health Care Coordination
- Community Health
- Organizational Skills
- Documentation Skills
- Attention to Detail
- Professional Engagement
- Empathetic Engagement
- HIPAA Compliance
Experience Level
- One (2) year of experience in case management, health care coordination, or community health preferred.
Education Level
- High School Diploma or equivalent required
- Associate’s Degree in Human Services, Preferred