ETE Field Navigator

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

Under the direct supervision of the Senior ETE Advisor, the ETE Field Navigator ensures the promotion of health and wellness of HIV+ and other SNP/Medicaid members through the oversight and development of a Plan of Care that encompasses the assessment of health and psychosocial needs, ongoing retention and engagement in care, high level adherence to antiretroviral therapy, health education and coaching on HIV disease, HIV primary and secondary risk reduction, and other co-morbid illnesses, and referral to community resources and services when appropriate. The ETE Field Navigator works in conjunction with ETE Advisors in a team-oriented approach. The ETE Field Navigator will be deployed to facilities throughout the boroughs of New York City to provide face-to-face case management.

• Provide face-to-face case management services to members at assigned health care facilities.
• Orients the assigned new member and reorients existing members to MetroPlus Health Plan and the scope of services the plan provides as needed.
• Ensures, formulates and validates an individualized Plan of Care utilizing various databases and collateral resources such as the member, care giver, primary care provider, and/or community level case manager to identify the needs and barriers of members living with HIV in order to promote the health and wellness of the member.
• Conducts Home Visits to members that are deemed lost to care.
• Ensures that the Plan of Care identifies appropriate goals and interventions.
• Promotes access to and oversees the coordination and delivery of comprehensive, quality healthcare services for HIV+, homeless, and transgender members.
• Performs telephonic case management activities where needed, including care coordination, planning for transition of care, out-patient follow-up and ancillary service review throughout the continuum of care to ensure optimum health outcomes.
• Provides health education on HIV disease, HIV primary and secondary risk reduction and other co-morbid illnesses, such as hepatitis C, diabetes and hypertension as indicated by the Plan of Care.
• Communicates with the member’s primary care provider, community case manager and all other applicable providers, vendors or agencies to facilitate the health and wellness of the member in a coordinated and comprehensive manner.
• Identifies service utilization trends and potential member needs by means of reviewing encounter data, pharmacy/prescription data, and the review of member health assessment tools.
• Documents in a comprehensive manner to ensure that all goals, interventions and care coordination activities for each member in the DCMS system and other applicable software programs are in compliance with professional standards and regulatory guidelines.
• Ensures each assigned new member has a completed Plan of Care within 30 days of enrollment and a reassessment of the Plan of Care every 180 days.
• Attend and prepare for facility based care coordination meetings to discuss newly enrolled, develop the plan of care, review members lost to care and provide follow-up on ETE members.
• Assists all MetroPlus departments with resolution of related member retention, utilization management, quality management, customer service, and provider relations concerns.
• Attends approved in-service and external education and training as per department directives.  
• Performs other appropriate duties and participates in other special projects as assigned, including, but not limited to, audit review and preparation, quality improvement, community health education, facility/provider relations and marketing activities.
• Ensures that coordination of membership enrolled in all lines of business is compliant with Federal, State, and City regulations, and are consistent with the Mission, Vision and Values of the organization.
• Other duties as assigned by manager.

• Associates degree from an accredited college or university in a healthcare-related field is preferred, 
• A minimum of two years of clinical experience in HIV care or support systems that includes experience in care coordination, health education and case management. A minimum of two years of experience in managed care is preferred.
• Excellent interpersonal, organizational communication and analytical skills.
• Computer literacy with proficiency with Microsoft Office products is required.
• Bilingual (English/Spanish) is preferred. Fluency in other languages is welcomed.

Professional Competencies

• Orients the assigned new member and reorients existing members to MetroPlus Health Plan and the scope of services the plan provides as needed.
• Provides health education on HIV disease, HIV primary and secondary risk reduction and other co-morbid illnesses, such as hepatitis C, diabetes and hypertension as indicated by the Plan of Care.
• Ensures that the Plan of Care identifies appropriate goals and interventions.
• Demonstrates the ability to effectively communicate with the member’s primary care provider, community case manager and all other applicable providers, vendors or agencies to facilitate the health and wellness of the member in a coordinated and comprehensive manner.
• Demonstrates competency in community-based field work to locate and engage individuals who are lost to care.