Job Description:

Under the direct supervision of the Enhanced Care Management Director, the Enhanced Care Management Member Navigator is a person with direct knowledge of the local community who functions as a “guide” and offers assistance to community members in “navigating” the health care and accessing related social and financial services to improve health outcomes. The Member Navigator performs a variety of health promotion, clerical and medical support services within the clinic setting and in the community. A primary function of the Member Navigator is to outreach and enroll eligible members into T.H.E.’s Enhanced Care Management Program (ECM) and maintain communication between members, their families, physicians, and the health care and social system(s) to help facilitate the care of individuals.

Essential Duties and Responsibilities:

● Conducts outreach and enrollment activities as directed to engage members identified as being ECM eligible. Works with care team staff to identify potential members to outreach and enroll into the ECM.

● Performs, as needed, member scheduling, program eligibility screening, broken appointment follow‐up, etc.

● Utilizes language and cultural awareness skills to outreach to members and community and present T.H.E.’s ECM Program in an acceptable manner.

● Works in collaboration with the Lead Care Manager to gather information from ECM enrolled members to complete comprehensive assessments, support care management planning, and implement health promotion strategies.

● Able to balance priorities and maintain outreach and enrollment goals.

● Offers services where ECM enrolled members live, seek care, or find most easily accessible and within health plan guidelines.

● Connects with ECM eligible or enrolled members via phone or in‐person to facilitate engagement, assessment, follow‐up, and education/training visits to support the Care Plans.

● Connects ECM enrolled members to other Community Supports / social services and supports they may need.

● Accompanies ECM enrolled members to office visits, as needed and according to health plan guidelines.

● Arranges transportation.

● Responsible to participate in care conference meetings.

● Coordinates with ECM resource partners to obtain data/information to ensure accurate Care Plan updates.

● Utilizes eCW and other electronic tracking systems to coordinate services and input data for reporting.

● Attends required ECM trainings.

● Assists with the required ECM reports, data entry, and other internal reports.

● Responsible for coordinating with individuals and/or entities to ensure a seamless experience for members and non‐duplication of services.

● Advocate on behalf of the member with health care professionals.

● Use motivational interviewing, self‐management support, trauma‐ informed care, and harm‐ reduction approaches.

● Meets with members at the hospital to support discharge planning and transitions of care.

● Coordinates with the Lead Care Manager to monitor treatment adherence and facilitate communication among members, their family supports, and care team as needed (e.g., hospital discharge plans, medication, etc.).

Other duties as assigned. Education and Qualifications:

● High school diploma or GED.

● Previous experience in a health care setting is preferred.

● Bilingual in English/Spanish (oral and written) Knowledge. Skills and Abilities:

● Knowledge about the communities and populations they are engaging.

● Strong documentation skills.

● Ability to speak the language of the member population served and/or effectively utilize interpretation/translation resources to ensure linguistically appropriate care is delivered.

● Ability to multi‐task and prioritize when needed.

● Ability to independently seek out resources and work collaboratively.

● Ability to develop and maintain good working relationships with staff.

● Ability to use computer and learn new software programs.

● Excellent interpersonal skills reflecting clarity, diplomacy, and the ability to communicate accurately and effectively with members and all levels of staff and management.

● Demonstrates ability to work in a regulatory climate that includes oversight of state and federal entities, payer contracts etc.

● Possesses ability to communicate effectively, both verbally and in writing.

● Proficient knowledge of Microsoft Outlook, MS Word, and Excel.

● Able to travel and attend professional meetings, conferences, trainings, and clinic sites.

● Performs other related duties as assigned