Community Health Navigator Sonoma, California

Job Details

Job Location
Sonoma County - Atlanta, GA

Position Type
Full Time

Salary Range
$26.00 - $31.00 Hourly

Job Category
Health Care

Description

Community Health Navigator

Sonoma, California

Summary

Come and join MedZed, an innovative ECM provider, as we deliver on our mission to "Inspire and Enable Better Health" for thousands of Californians. Community Health Navigators (CHN) for our Enhanced Care Management (ECM) Program are a front-line, field-based team that work to impact the health and well-being of CalAim populations in their local market. This position is for those passionate about the MedZed mission and for those who can embrace our STRIVE (Service Excellence, Team, Results Driven, Integrity, Vision, and Evolution) values daily. This individual is focused on delivering patient centric care and support to each member enrolled into the ECM program. This is a remote-field position who is primarily in the community coordinating services with members, providers, and community agencies to improve member care, and long-term outcomes. We actively work with special populations, who may include the home insecure, may have serious mental illness or substance use disorders, and/or may need services to prevent such conditions. Our dream candidates possess strong interpersonal skills with the ability to build and maintain team and community relationships while reporting to a local/regional Program Manager.

Daily Responsibilities

• Manage caseloads of referred, assigned, and enrolled members with complex medical, social, and psychosocial needs.
• Communicates effectively with members, caregivers, and/or families, in person and remote, to cultivate professional, supportive relationships.
• Understand social/complex case management and while participating in clinical rounds, case consultations, and team huddles.
• Empower members and families to overcome barriers and improve health outcomes.
• Serve vulnerable populations that may include the following: homeless, severe mental illnesses, substance use disorders, addiction, medically underserved, at risk children/youth, disabled, chronic illnesses, high utilizers of emergency services, etc.
• Complete member assessments including, but not limited to, safety/risk assessments, health needs assessments, and psychosocial needs assessments.
• Develop and create unique care plans for members, care givers, and/or families to support identified needs.
• Assist members with service coordination including scheduling appointments, booking transportation, and assisting with referrals/authorizations.

• Consult and collaborate with other healthcare team members, hospitals, provider offices, service/delivery agencies, community agencies, and/or social service programs
• Provide discharge planning support, and post discharge support as appropriate including collaboration with inpatient hospital teams and/or providers.
• Accompany members to health appointments if needed, no transportation of members required
• Manage ongoing follow up with members/families via phone calls, home visits, and community setting visits to ensure members are achieving health care goals and receiving appropriate resources.
• Maintain professional, accurate and quality records by documenting them in a timely manner into our care management system.
• Other duties as assigned.

Qualifications

Job Qualifications

• Proven understanding of patient centered care
• Proven experience with care planning, case management, and managing caseloads
• Proven experience working with vulnerable and culturally diverse populations (homeless, high utilizers, at risk child/youth, severe mental illness, chronic conditions, etc.)
• Knowledge of community resources within the community of the member being served
• Ability to maintain clear and professional boundaries with members and coworkers
• Have a basic understanding of different therapeutic services including but not limited to physical therapy, occupational therapy, speech therapy, applied behavioral analysis therapy, etc.
• Knowledge of process for referrals and authorizations in federal, state, local and community-based organizations
• Ability to quickly establish and maintain rapport and trust with members
• Ability to problem solve, critically think, and collaborate effectively
• Experience with clinical rounding and collaboration with multidisciplinary team.

• Ability to identify mental health concerns, substance use concerns, medical issues, need for durable medical equipment and/or other needs.
• Experience with child, youth, and families (if hired to work with the pediatric population)
• For Pediatric Populations, Knowledgeable about IEPs, 504 plans, Regional Centers, Wrap around programs, Child Welfare/Foster Care, School-based programs, etc.
• Must be able to thrive in a fast-paced environment that is constantly evolving with new requirements and innovative program delivery techniques
• Ability to follow HIPAA standards in safeguarding patient information
• Able to work with Microsoft Office, Excel, and Outlook (email)
• Have a Valid Driver's License
• Access to an insured and reliable car
• Bilingual Spanish

Education & Work Experience

• Bachelor's degree (social work, psychology, sociology or public health a plus)
• Master's degree a plus (MSW)
• Minimum of 2 years' experience working in medical, mental health, social or community services required
• Minimum of 1 years' experience with ages 0-21 years of age (if hired to work with the pediatric