Community Health Navigator

Community Health Navigator

The Community Health Navigator is responsible for supporting members with low- to moderate-risk care needs by conducting outreach, addressing social determinants of health (SDOH), promoting preventive care, and connecting members with the resources and services they need. This role works collaboratively with care management teams, healthcare providers, and community organizations to improve member engagement and health outcomes.

Establish relationships and serve as the primary point of contact for a targeted member population, including select high-risk members, through home visits and outreach calls. Identify social determinants of health (SDOH) needs and coordinate appropriate resources and support. Exercise sound judgment and discretion when coordinating care by completing routine follow-up activities and collaborating with the care management teams, community-based healthcare providers, and community organizations. Inform members of the actions required to meet HEDIS, EPSDT, health plan requirements, and other outreach initiatives through phone calls and home visits, while encouraging compliance. Assist members in overcoming barriers to care and promote strong relationships with their primary medical and dental providers.

Develop and maintain relationships with new and existing community organizations through telephone, email, mail, and in-person visits. Collaborate with internal departments and external agencies to obtain information that supports the success of health education and health promotion initiatives. Educate members and their representatives regarding available health plan benefits, community resources, and support services.

Associate's degree in healthcare, Human Services, or a related field, or an equivalent combination of education and relevant work experience. A minimum of one (1) year of experience in a healthcare office, clinic, hospital, or human services setting. Community-based care experience preferred. Knowledge of medical terminology and common disease processes. Ability to effectively communicate preventive health practices and health management concepts to members and community agencies. Comprehensive knowledge of Medicaid requirements, health plan policies, and procedures. Knowledge of managed care principles and practices.

At Enlightened, we pride ourselves on offering a comprehensive and industry-competitive benefits package to our full-time employees. Our benefits include: Medical/Dental/Vision Insurance with Health Savings Accounts (HSA) Flexible Spending Accounts (FSA) 401(k) Retirement Plan Paid Holidays, Vacation, & Sick Leave Professional Training & Development Reimbursement Please note, these benefits are available exclusively to full-time employees of Enlightened.

Enlightened is proud to be an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, disability, or any other federal, state, or local protected class.