Santa Clara Family Health Plan
Health Plan Navigator (South County/Gilroy)
Santa Clara Family Health Plan, San Jose, California, United States, 95199
Health Plan Navigator (South County/Gilroy)Salary Range:
$64,342 - $96,513The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.FLSA Status:
Non-ExemptDepartment:
Community EngagementReports To:
Manager, Community Resource Center (South County)Employee Unit:
Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521.GENERAL DESCRIPTION OF POSITIONThe Health Plan Navigator is committed to supporting Santa Clara Family Health Plan members and community residents in accessing services and information at the Community Resource Center(s) (CRC). Through excellent customer service and member journey care coordination, including navigation of the health care system, managed care processes, and following up to close the loop (to track progress and outcomes of referrals), the Health Plan Navigator contributes to making the health of communities more equitable. The Health Plan Navigator has a multifunctional role, which includes helping members and residents understand and access health plan benefits, including health care services, as well as overcome barriers to accessing health and social services through connection to internal and external resources and support. The Health Plan Navigator also provides back-up support for the CRC front desk in a manner that maintains compliance with SCFHP policies and procedures, and business requirements.ESSENTIAL DUTIES AND RESPONSIBILITIESTo perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below:Act as the primary point of contact and navigator for SCFHP members walk-in to CRC, and community residents regarding health care services and programs, concerns or requests for health care benefits and community resource information.Use effective communication skills to directly follow up with community organizations who received the member referrals to ensure services were rendered in a timely manner.Communicate effectively with different departments or teams within the organization to ensure a seamless transfer by following through and closing the loop on cases forwarded to other departments for assistance.Develop and maintain clear documentation for each member's interactions and track progress and follow-ups (e.g., close the loop).Plan, coordinate and provide member orientation educational presentations in an engaging and professional manner with a mid to large size group (10-50 people).Understand what health care services and programs are available internally and externally for members.Plan and conduct intentional outreach among members to promote health events being hosted at the CRC.Directly communicate with members who come to the CRC to help them understand and get connected with their Primary Care Physician (PCP).Educate and assist members in navigating and accessing services in a manner that achieves excellent service standards.Serve as a back-up support for the front desk in the daily operations at the CRC.Follow established guidelines and resources to respond to member, resident, and partner inquiries.Work collaboratively and effectively with other departments when resolving member or partner issues.Represent SCFHP and support CRC services, activities and events as needed.Document all contacts and follow-up actions regarding member, resident, and partner communications.Assist with designated telephone and non-telephone tasks.Attend and actively participate in departmental and non-departmental meetings.Act as interpreter when supporting non-English speaking residents.Perform other related duties as required or assigned.REQUIREMENTS – Required (R) Desired (D)Associate’s Degree in a health-related field or equivalent experience, training, or coursework. (R)Minimum three years of experience in Health Care Coordination or Resource Navigation. (R)Minimum two years of direct experience helping clients or members in-person. (R)Fluent in Spanish, Vietnamese, and/or Chinese (Mandarin and/or Cantonese). (R)Prior experience with managed care plans, Medi-Cal and Medicare programs. (D)Experience working with underserved populations. (R)Proficient in adapting to changing situations and efficiently alternating focus between tasks. (R)Working knowledge of applicable computer software including Outlook, Word, and Excel. (R)Ability to use keyboard with moderate speed and a high level of accuracy. (R)Excellent communication skills. (R)Ability to think and work effectively under pressure. (R)Ability to maintain confidentiality. (R)Ability to comply with all SCFHP policies and procedures. (R)CPR/First Aid Certification or ability to acquire certification within 3 months. (R)Ability to work evenings and weekends as needed. (R)WORKING CONDITIONSGenerally, duties are primarily performed in an office environment while sitting or standing at a desk.PHYSICAL REQUIREMENTSIncumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:Mobility Requirements: regular bending at the waist, reaching overhead, and sitting or standing for extended periods of time.Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 15 pounds.Visual Requirements: ability to read information in printed materials and on a computer screen.Dexterity Requirements: regular use of hands, wrists, and finger movements.Hearing/Talking Requirements: ability to hear normal speech and communicate effectively.Reasoning Requirements: ability to think effectively under pressure and maintain attention to detail.ENVIRONMENTAL CONDITIONSGeneral office conditions. May be exposed to moderate noise levels.EOE
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$64,342 - $96,513The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.FLSA Status:
Non-ExemptDepartment:
Community EngagementReports To:
Manager, Community Resource Center (South County)Employee Unit:
Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521.GENERAL DESCRIPTION OF POSITIONThe Health Plan Navigator is committed to supporting Santa Clara Family Health Plan members and community residents in accessing services and information at the Community Resource Center(s) (CRC). Through excellent customer service and member journey care coordination, including navigation of the health care system, managed care processes, and following up to close the loop (to track progress and outcomes of referrals), the Health Plan Navigator contributes to making the health of communities more equitable. The Health Plan Navigator has a multifunctional role, which includes helping members and residents understand and access health plan benefits, including health care services, as well as overcome barriers to accessing health and social services through connection to internal and external resources and support. The Health Plan Navigator also provides back-up support for the CRC front desk in a manner that maintains compliance with SCFHP policies and procedures, and business requirements.ESSENTIAL DUTIES AND RESPONSIBILITIESTo perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below:Act as the primary point of contact and navigator for SCFHP members walk-in to CRC, and community residents regarding health care services and programs, concerns or requests for health care benefits and community resource information.Use effective communication skills to directly follow up with community organizations who received the member referrals to ensure services were rendered in a timely manner.Communicate effectively with different departments or teams within the organization to ensure a seamless transfer by following through and closing the loop on cases forwarded to other departments for assistance.Develop and maintain clear documentation for each member's interactions and track progress and follow-ups (e.g., close the loop).Plan, coordinate and provide member orientation educational presentations in an engaging and professional manner with a mid to large size group (10-50 people).Understand what health care services and programs are available internally and externally for members.Plan and conduct intentional outreach among members to promote health events being hosted at the CRC.Directly communicate with members who come to the CRC to help them understand and get connected with their Primary Care Physician (PCP).Educate and assist members in navigating and accessing services in a manner that achieves excellent service standards.Serve as a back-up support for the front desk in the daily operations at the CRC.Follow established guidelines and resources to respond to member, resident, and partner inquiries.Work collaboratively and effectively with other departments when resolving member or partner issues.Represent SCFHP and support CRC services, activities and events as needed.Document all contacts and follow-up actions regarding member, resident, and partner communications.Assist with designated telephone and non-telephone tasks.Attend and actively participate in departmental and non-departmental meetings.Act as interpreter when supporting non-English speaking residents.Perform other related duties as required or assigned.REQUIREMENTS – Required (R) Desired (D)Associate’s Degree in a health-related field or equivalent experience, training, or coursework. (R)Minimum three years of experience in Health Care Coordination or Resource Navigation. (R)Minimum two years of direct experience helping clients or members in-person. (R)Fluent in Spanish, Vietnamese, and/or Chinese (Mandarin and/or Cantonese). (R)Prior experience with managed care plans, Medi-Cal and Medicare programs. (D)Experience working with underserved populations. (R)Proficient in adapting to changing situations and efficiently alternating focus between tasks. (R)Working knowledge of applicable computer software including Outlook, Word, and Excel. (R)Ability to use keyboard with moderate speed and a high level of accuracy. (R)Excellent communication skills. (R)Ability to think and work effectively under pressure. (R)Ability to maintain confidentiality. (R)Ability to comply with all SCFHP policies and procedures. (R)CPR/First Aid Certification or ability to acquire certification within 3 months. (R)Ability to work evenings and weekends as needed. (R)WORKING CONDITIONSGenerally, duties are primarily performed in an office environment while sitting or standing at a desk.PHYSICAL REQUIREMENTSIncumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:Mobility Requirements: regular bending at the waist, reaching overhead, and sitting or standing for extended periods of time.Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 15 pounds.Visual Requirements: ability to read information in printed materials and on a computer screen.Dexterity Requirements: regular use of hands, wrists, and finger movements.Hearing/Talking Requirements: ability to hear normal speech and communicate effectively.Reasoning Requirements: ability to think effectively under pressure and maintain attention to detail.ENVIRONMENTAL CONDITIONSGeneral office conditions. May be exposed to moderate noise levels.EOE
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