Community Health Care Navigator

About the role: Support Medicaid Members to understand their rights, benefits and responsibilities under Medicare, Medicaid and related managed care programs

We are seeking a compassionate, self-motivated and dedicated individual to join our HealthCare Navigation team and lead the new services associated with the Independent Consumer Advocacy Network (ICAN), a program in New York State that helps people with Medicare, Medicaid, and managed care plans to understand and exercise their rights, navigate health insurance issues, and resolve problems with their coverage and care

Key Responsibilities

Member Engagement:

Ø Educate members and their caregivers on the scope of their Managed Long-term Care (MLTC) benefits, how to access services e.g., home care, adult day health care, transportation, and their rights and responsibilities.

Ø Conduct initial and ongoing assessments of members' needs, preferences, social determinants of health, and understanding of their MLTC plan.

Ø Act as a trusted point of contact for member questions regarding enrollment, disenrollment, and service authorization processes.

Ø Promote health literacy and self-advocacy skills among members.

Care Coordination and Service Access:

Ø Coordinate referrals to a comprehensive network of providers and community resources ensuring timely access to necessary MLTC-covered services.

Ø Troubleshoot and resolve barriers to care, such as transportation issues, appointment scheduling conflicts, or difficulties with authorization approvals.

Ø Act as a liaison between the member, providers, the MLTC plan, and social services agencies.

Administrative and Compliance:

Ø Maintain accurate and timely documentation of all member interactions, service coordination efforts, and outcomes in Salesforce.

Ø Ensure all activities comply with federal and state regulations, Medicaid MLTC guidelines, and organizational policies.

Ø Assist members with Medicaid recertification and other administrative tasks critical to maintaining their MLTC eligibility.

Ø Maintain and submit necessary documentation and reporting about services provided, outcomes, and performance metrics

Ø Participate in provider, funder and network meetings as well as weekly HealthCare Navigation meetings

Qualifications:

Ø Demonstrated experience working with Medicaid populations and specifically individuals with disabilities who require long-term services and supports.

Ø Expert knowledge of the Medicaid MLTC program

Ø Strong organizational and problem-solving skills with an ability to manage a demanding caseload.

Ø Proficiency in utilizing case management software and electronic health records.

Ø Bilingual skills (e.g., Spanish and English) is a significant asset, depending on the service area.

Ø Exceptional interpersonal, communication (written and verbal), and active listening skills.

Ø Compassionate, empathetic and patient-centered with ability to handle sensitive and maintain confidentiality

Education:

Ø Associate’s or Bachelor’s degree preferred; Graduate degree in Social Work, Public Health, Healthcare Administration, or a related field is preferred

Ø Minimum of two (2) years of experience in a healthcare, managed care, or social service setting

Equal Employment Opportunity Statement

It is the policy of Rising Ground that the Agency wholly complies with equal treatment of all employees and applicants for employment without unlawful discrimination as to an individual’s perceived or actual race, creed, color, national origin, alienate, citizenship status, gender, age, disability, marital status, partnership status, sexual orientation, ethnicity, religion, or veteran status in all employment decisions, including but not limited to recruitment, hiring, compensation, training and apprenticeship, promotion, upgrading, demotion, downgrading, transfer, layoff and termination and all other terms and conditions of employment.