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/field-based – Associate must be able to travel to the Pennsylvania counties served.
• Approximately 95% travel required throughout Berks, Lehigh, Lancaster, Delaware, and Chester counties to meet with members in hospitals, homes, or community locations.
   

Responsibilities:

Community Education

• Develops and maintains relationships with new and established community organizations via phone, mail, e-mail and personal visits.
• Collaborates with internal departments and external agencies to obtain data that is pertinent to the overall success of health education/promotion programs.
• Provides education to members and member representatives regarding nursing facility transitions and available benefits.

Member Outreach:

• Establishes connection for Long-Term Services and Supports members, identified as unable to reach through unannounced home visits and outreach calls.
• Exercises judgment and discretion in the coordination of care by handling basic care follow up tasks and collaborating with AmeriHealth Caritas case management teams, community based health care providers, and other organizations.
• Performs outreach calls to members to identify barriers and/or unmet needs.
• Informs members of the required actions to fulfill HEDIS, EPSDT, and Plan requirements and other referred outreach, through phone calls or home visits, and encourages them to comply.
• Assists in addressing members’ barriers to care and to encourage/foster relationships with their medical/dental providers (medical/dental homes.
• Coordinates with Primary Care Physicians for the completion of Comprehensive Medical Reports needed for annual redeterminations.
• Assists members with obtaining community resources and DME.
• Performs in-facility assessments on Long-Term Services and Supports members with an interest in transitioning out of the nursing facility.
• Assists in the transition of members from the nursing facility to community by assisting to obtain birth certificates, identification cards, social security cards and award     letters, shopping for approved household items and sets up those items.
• Performs initial telephonic outreach to new members and acts as a back up to the personal care coordinators.
• Performs tasks as assigned by Long-Term Services and Supports management team to support members.
• Documents contact with members within the case management system.

Education/Experience:

• Associate’s Degree in Health Care, Human Services, or a related field or equivalent work experience (Behavioral Health or Substance Abuse) preferred.
• Bachelor’s Degree preferred.
• Minimum of 2 (two) years of health care in an office/clinic/hospital setting or human services experience.

Licensure:

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

Other Skills:

• Community based care experience preferred.
• Knowledge of Medicaid requirements and plan, policies and procedures.
• Knowledge of managed care.
• 95% of time will be spent traveling.
• Physical ability to perform tasks that may require prolonged standing, sitting, and other activities necessary to perform job duties such as lifting premium giveaways, educational materials, and household items for set-up.
• Knowledge of and experience working with vulnerable populations preferred.
• Knowledge of and experience with substance use disorder and behavioral health preferred.
• Understand how to collaborate with a variety of different people and roles.
• Show strong growth mindset and are able to learn from setbacks.
• Stay focused and organized while juggling multiple deadlines.
• Ability to carefully handle confidential or time-sensitive information.
• Knowledge and experience with locating housing.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.