Community Health Navigator

Role Overview: The Community Health Navigator focuses on engaging members through outreach and in-person visits, identifying and addressing Social Determinants of Health (SDOH) needs, improving access to healthcare services, and supporting members in navigating available benefits, community resources, and promoting preventive care, reducing barriers to care, and connecting members to programs that support their overall health and well-being.

Work Arrangement:

• Remote – Associate must be in one of the service areas in the state of Michigan (MI)
• Field-based role with approximately 95% travel required throughout the Wayne, Macomb, and Oakland counties service areas to meet with members in the hospitals, home, or community location.

Responsibilities:

• Establishes connections for a targeted member population, including some high-risk members, through home visits and outreach calls.
• Identifies Social Determinants of Health (SDOH) needs and addresses them appropriately, effectively, and efficiently, utilizing all available resources.
• Exercises judgment and discretion in the coordination of care by handling basic care follow-up tasks and collaborating with AmeriHealth Caritas care management teams, community-based health care providers, and other organizations.
• Informs members of the required actions to fulfill Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), and Plan requirements, as well as other referred outreach, via phone calls or home visits, and encourages them to comply.
• Assists in addressing members’ barriers to care and encourages/fosters relationships with their providers
• Develops and maintains relationships with new and established community organizations via phone, mail, e-mail, or personal visits.
• Provides education to members and member representatives regarding available benefits.

Education & Experience:

• Associate’s degree in health care, human services, or a related field, or 2 plus years of equivalent experience working in community outreach required.
• Bachelor’s Degree preferred.
• 2 years of experience in healthcare or managed care in an office/clinic/hospital setting
• Peer Support Certification preferred.
• Community-based care experience required.
• Previous experience presenting health education materials to individuals and small groups.
• Knowledge and understanding of medical terminology and disease processes.
• Comprehensive knowledge of Medicaid requirements and plan, policies, and procedures.

Licensure:

• Valid driver's license, car insurance, and reliable transportation required.

Skills & Abilities

• Strong understanding of SDOH and their impact on health outcomes.
• Knowledge of Medicaid programs, MCOs, and health plan operations.
• Familiarity with HEDIS, care management, and preventive health initiatives.
• Working knowledge of medical terminology, disease processes, and healthcare delivery systems.
• Ability to educate, motivate, and engage diverse member populations.
• Strong problem-solving and critical-thinking skills with the ability to assess member needs and identify appropriate solutions.
• Excellent verbal, written, and interpersonal communication skills.
• Ability to build productive relationships with members, providers, community organizations, and internal stakeholders.
• Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment.
• Proficiency with Microsoft Office applications, including Outlook, Word, Excel, Teams, and SharePoint.

• Ability to work independently in a field-based environment while maintaining collaboration with remote teams.