Care Navigator

Job Description

Job Description

Description:

The Care Navigator serves as a trusted liaison who empowers individuals and families to improve their health and well-being. Through culturally tailored outreach and hands-on support, the Care Navigator helps individuals and families navigate health and social systems, overcome barriers, and connect to essential resources like housing, food, and employment. The ideal candidate is empathetic, organized, community-focused, deeply committed to advancing health equity, and open to learning new skills and evolving with the role.

• Conducts comprehensive intake assessments and determines eligibility for Enhanced Care Management (ECM). Works with providers to assess client needs.
• Assists clients with Medi-Cal and other program eligibility, including coverage navigation and accessing their managed care plan benefits. Connects uninsured clients with community resources for accessing health insurance.
• Addresses barriers to health by identifying and connecting clients to services such as housing, food, transportation, and employment.
• Connects clients to health education and primary care providers to support prevention and management of chronic health conditions. Connects clients with behavioral health services and programs.
• Coordinates and advocates with healthcare and social service providers on behalf of clients
• Supports clients with perinatal and maternal health needs by coordinating care and providing connection to resources.
• Builds clients capacity to access community resources such as housing and food; monitors follow-up to ensure access.
• Engages with clients in a culturally and linguistically responsive manner to ensure health and social services are accessible and aligned with clients’ preferences.
• Leads care coordination for clients with complex physical and behavioral health conditions; provides intensive case management including care planning and coordinating across providers and systems.
• Serves as the primary point of contact for the client, client’s family, authorized representative
• (AR), caregiver, or other authorized support person(s), as appropriate, and the multidisciplinary care team providing care to the client.
• Uses client-centered approaches, such as health coaching, to help individuals set realistic goals for improving their health and encourages and motivates them to reach their goals.
• Collaborates with clients and/or their parent, caregiver, guardian, and multidisciplinary team to develop comprehensive, personalized care plans based on clients’ needs to ensure a whole-person approach is taken in identifying gaps in treatment or gaps in available and needed services. Monitors care plan progress with clients.
• Builds clients capacity to access and navigate complex healthcare and community systems. Follows up to ensure connection to services.
• Schedules and accompanies clients to health and wellness appointments, and arranges transportation to appointments, as needed.
• Meets with clients in person, offering services where clients live, seek care, or other preferred location.
• Performs outreach to identify and engage members eligible for ECM services, including field visits, phone calls, and mailing information.
• Educates clients on wellness and prevention strategies and resources during one-on-one and group interactions.
• Utilizes evidence-based practices and tools based on organizational priorities and training.
• Promotes trust and rapport with clients through empathy and consistent follow-up.
• Communicates effectively with clients, interdisciplinary team members, and community partners
• Maintains timely, complete, and accurate documentation of client services and referrals in the organization’s data systems with attention to billing requirements.
• Participates in case conferencing and meets regularly with the ECM clinical consultant to review care plans and receive case guidance.
• Completes ECM and other required training.
• Meets productivity and performance targets for outreach, member contacts, and documentation
• Ensures compliance with client privacy regulations and other confidentiality policies when handling client information.
• Operates in compliance with agency procedures and Medi-Cal guidelines for Enhanced Care Management services.
• Perform other duties as required by the needs of the organization
• Participate in all required agency events

Education and Certification:

• High school graduate or GED
• Associate or Bachelor’s degree preferred for CHWs providing ECM services
• Community Health Worker Certificate required, or obtain one within 6 months of start date

Experience

• A minimum of 18 months working to support the health or social well-being of marginalized, high-risk, and underserved populations
• Experience using a computer for documentation, communication, and organizing daily tasks, including Microsoft Office and databases
• Lived experience that aligns with and provides a connection between the CHW and the Member or population being served.

Other Qualifications

• Fluent in Spanish
• Cultural responsiveness and cultural humility
• Client-centered, e.g., active listening skills, empathy, and compassion for others
• Ability to exercise judgment in carrying out job responsibilities
• Strong organization and time management skills, and ability to prioritize and work under pressure in a fast-paced, high-volume environment.
• Excellent oral and written communication skills
• Interest in opportunities to grow and learn on the job
• Flexibility, adaptability, and problem-solving skills
• Available for 8-hour shifts at the worksite with start times 8:30-10:00 am and end times 5:00-7:00 pm, and occasional evening or weekend hours as needed
• Ability to drive and have a reliable vehicle with car insurance