Job Description

The Community Health Worker-Navigator is responsible for conducting Health-Related Social Needs (HRSN) Screenings within the Social Care Network (SCN) to identify unmet needs and ensure that members are appropriately referred for further support. This role requires accurate data entry in the assigned platform, confirmation of Medicaid eligibility, obtaining informed consent, and proper documentation for Medicaid-billable services. The Community Health Worker- Navigator is often the first point of contact for members and plays a critical role in ensuring timely connection to Enhanced Care Management.

Essential Duties and Responsibilities

• Accept referrals and initiate screenings after confirming Medicaid status and SCN eligibility.
• Search for members in the designated platform; create or update member profiles as appropriate.
• Verify consent status and obtain new consent if required.
• Administer the HRSN Community Health Worker- Navigator, reading questions aloud and documenting responses accurately.
• Manage sensitive questions (e.g., interpersonal violence) with discretion, documenting “declined” or “not asked” responses as appropriate.
• Track and document time spent, participants involved, and any declined screenings.
• Submit completed screenings in the designated platform for review.
• Conduct re-screening only when a major life event has occurred (e.g., hospitalization, housing change, incarceration, loss of benefits).
• Document reasons for re-screening, date/time, and duration.
• Accept referrals in the assigned software system and conduct outreach (3 attempts within 5 business days).
• Engage members, confirm needs, and obtain consent.
• Complete Eligibility Assessment to determine Standard vs. Enhanced Services.
• Connect members to community resources or Enhanced CM agencies.
• Document all steps and close or transition cases as appropriate.
• Submit units for reimbursement per the approved fee schedule.
• Refer members with unmet needs to Enhanced Care Management using the Assigned software system referral process.
• Document needs and context in the referral description to ensure continuity of care.

Requirements

Qualifications

• High School Diploma or equivalent required or Associate’s Degree in Human Services, preferred.
• One (2) year of experience in case management, health care coordination, or community health preferred.
• Bilingual (English/Spanish) strongly preferred.
• Strong organizational, documentation, and data-entry skills with attention to detail.
• Ability to engage with diverse populations professionally and empathetically.

Core Competencies

• Accuracy & Compliance: Ensures proper documentation for Medicaid-billable services.
• Member-Centered Engagement: Builds rapport, obtains informed consent, and handles sensitive topics with care.
• Collaboration: Works closely with Navigators, Eligibility Specialists, and Enhanced Care Management partners.
• Confidentiality: Adheres to HIPAA, agency, and funder compliance requirements.

Physical Demands:

The position does require occasional standing, squatting, lifting of up to approximately 10 lbs. and frequent sitting.