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Health Plan Navigator
2 months ago
Department: Community Engagement
Reports 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 POSITION
The 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 RESPONSIBILITIES
To 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. Follow available resources in the community that address the health care and social needs of members and residents; and use this information to navigate, refer, and close the loop with members in their health care and resource access journey experience.
- 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.
- To help with coordination and navigation of member health care and/or resource needs, communicate effectively with different departments or teams within the organization to ensure a seamless transfer by following through and closing the loop on cases forward 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). Enter data into an appropriate software to continuously track and review data.
- Plan, coordinate and provide member orientation educational presentations in an engaging and professional manner with a mid to large size group (10-50 people) resulting in a high level of customer satisfaction.
- Understand what health care services and programs are available internally and externally for members in order to close their care gaps.
- Based on the member needs of health care and social resources, plan and conduct intentional outreach (e.g., phone calls, in-person meetings) among members to promote health events (e.g., flu clinics) being hosted at the CRC that may help to address member health care gaps.
- Directly communicate with members who come to the CRC to help them understand and get connected with their Primary Care Physician (PCP) and receive wellness checks within the appropriate timeline, based on quality requirements. Help with the navigation of members getting connected with their PCP.
- Educate and assist members in navigating and accessing services in a manner that achieves excellent service standards and maintains high customer satisfaction.
- Serve as a back-up support for the front desk in the daily operations at the CRC during lunch, breaks, PTO, and during spikes in activity requiring additional resources.
- Follow established guidelines and resources to respond to member, resident, and partner inquiries and resolve concerns in an accurate, timely, respectful, professional and culturally competent manner.
- Work collaboratively and effectively with other departments when resolving member or partner issues, report relevant information to Management.
- Represent SCFHP and support CRC services, activities and events as needed at scheduled times during and after regular business hours, including weekends, such as outreach events, health fairs, etc.
- Appropriately categorize and accurately document all contacts and contact methods (walk-in, telephone and non-telephone activities) and follow-up actions regarding member, resident, and partner communications in health plan data base systems, in accordance with established guidelines.
- Assist with designated telephone and non-telephone tasks, including follow-up on cases related to access to services, or other escalated issues/calls within required timeframes.
- Attend and actively participate in daily, weekly, and monthly departmental and non-departmental meetings, in-services, training and coaching sessions.
- Act as interpreter when supporting non-English speaking residents.
- Perform other related duties as required or assigned.
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.
- Associate's Degree in a health related field or equivalent experience, training, or coursework. (R)
- Minimum three years of experience in a Health Care Coordination or Resource Navigation/Coordination, , preferably within a Health Care or Health Plan setting,
- Minimum two years of direct experience helping clients or members in-person, with the demonstrated ability to help in one-on-one setting and/or group-based presentations. (R)
- Fluent in Spanish, Vietnamese, and/or Chinese (Mandarin and/or Cantonese); able to successfully pass spoken language certification testing. (R)
- Prior experience with managed care plans, Medi-Cal and Medicare programs (D)
- Working with underserved populations. (R)
- Proficient in adapting to changing situations and efficiently alternating focus between telephone and non-telephone tasks to support CRC operations as dictated by business needs. (R)
- Working knowledge and the ability to efficiently operate all applicable computer software including applications such as Outlook, Word and Excel. (R)
- Ability to use keyboard with moderate speed and a high level of accuracy. (R)
- Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP Plan members, residents, and partners over the telephone, in person or in writing. (R)
- Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
- Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
- Ability to maintain confidentiality. (R)
- Ability to comply with all SCFHP policies and procedures. (R)
- Ability to perform the job safely with respect to others, to property and to individual safety (R)
- CPR/First Aid Certification or ability to acquire certification within 3 months. (R)
- Ability to work evenings and weekends as needed. (R)
Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.
PHYSICAL REQUIREMENTS
Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:
- Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
- Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 15 pounds; (R)
- Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
- Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
- Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
- Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)
ENVIRONMENTAL CONDITIONS
General office conditions. May be exposed to moderate noise levels.
