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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 support. This role requires accurate data entry, Medicaid eligibility confirmation, informed consent, and documentation for Medicaid-billable services, playing a critical role in connecting members to Enhanced Care Management.
Responsibilities
- Conduct Health-Related Social Needs (HRSN) Screenings.
- Identify unmet needs and refer members for support.
- Perform accurate data entry in the assigned platform.
- Confirm Medicaid eligibility.
- Obtain informed consent.
- Document Medicaid-billable services.
- Accept referrals and initiate screenings.
- Search for members and create/update member profiles.
- Verify consent status and obtain new consent if required.
- Administer HRSN screenings, reading questions aloud and documenting responses.
- Manage sensitive questions with discretion.
- Track and document time spent, participants, and declined screenings.
- Submit completed screenings for review.
- Conduct re-screening after major life events.
- Document reasons, date/time, and duration for re-screening.
- Accept referrals 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.
- Submit units for reimbursement per the approved fee schedule.
- Refer members with unmet needs to Enhanced Care Management.
- Document needs and context in referral descriptions for 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.
- 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
- Engagement with Diverse Populations
- HIPAA Compliance
Experience Level
- 1-2 years experience in case management, health care coordination, or community health preferred
Education Level
- High School Diploma or equivalent
- Associate's Degree in Human Services preferred