Health Care Navigator

Fallon Health offers a Program of All Inclusive Care for the Elderly (PACE) to serve the health needs of dual-eligible residents of the greater Buffalo area including Erie and Niagara counties. FHW Care Navigator The primary role of the Navigator is to advocate for the Participants and/or caregivers. The Navigator assists and works closely with the Home Care Coordinator Nurse acting as the community liaison ensuring satisfaction of the provisional authorized services developed via the plan of care. Responsibilities include managing referrals/authorizations and coordination of services of the plan of care. Under the direction of the Clinical Nurse Manager, the Navigator assures timely completion of assigned work in conformance with established departmental policies and procedures. Able to demonstrate independent action. The Navigator presents a clear definition of problem(s) when reviewing with the inter-disciplinary team, clinical staff and other members of Fallon Health Weinberg. Primary Job Responsibilities Outreaches to all Fallon Health Weinberg Participants via the telephone and/or in person as per state and organization recommendations Ensure care plan provisional services are being met and satisfied Acts as Participant advocate Responds to Participant/caregiver/Facility questions or concerns regarding authorized in-home services. Makes in home/institutional/office visits as need be to introduce self/role and ensure the Participant/caregiver/facility is orientated to the Program and benefits Coordinates and ensures members of the IDT (Clinical Nurse Manager, Home Care Coordinator, and others) are involved and knowledgeable about the Participant status based upon Enrollee always need and PCP/PCT direction Ensures authorizations for specific covered services are entered into the EHR as appropriate based upon authorized services Ensures the Home Care Coordinator follows up with Participant after an emergent/urgent care need and/or care transition such as a hospitalization or skilled nursing facility admission $23.00 per hour Qualifications Education High School Diploma. License/Certifications Access to reliable transportation. CPR certification, or willingness to be certified within 60 days of hire, is essential Experience At least one year caring for the frail or elderly population. Home care or personal care experience preferred. Telephonic/ In-person interviewing skills preferred. Ability to transport self to/from meetings with Participants and/or vendor agencies in/around the program services area #J-18808-Ljbffr