Job Description

FLSA Status: Non-exempt
Department: Health Services – Community-Based Programs
Reports To: Manager, Social Determinants of Health

Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521

GENERAL DESCRIPTION OF POSITION
The Health Navigator is responsible for providing on-going care coordination services for both Santa Clara Family Health Plan (SCFHP) members and other residents at designated supportive housing sites. Under the direction of the Manager, Social Determinants of Health, the Health Navigator will be proactive and responsive to members and residents ‘needs in a friendly and professional manner. The Health Navigator provides health navigation support to help coordinate resources and services and support safety and housing retention for individuals at designated housing locations. The Health Navigator will work in close collaboration with housing staff and participants of the member/resident’s care team to ensure needed services are provided. The Health Navigator will also act as a liaison to SCFHP and its providers to solicit participation in case management, community-based programs, and primary care services. The applicant must be a proactive team player who is also able to work independently in assigned communities and build rapport with diverse members, residents, providers and local partner agencies.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

1. Provide on-site and in-person orientation and health navigation services for SCFHP members and other residents/clients in collaboration with housing provider on-site staff and other members of the care team as appropriate.
2. Educate member on managed care and how to navigate and access the health care system, benefits, and services including (but not limited to): health education, case management, behavioral health, primary care, vision, nurse advice line, enhanced care management, community supports, and appropriate use of the emergency department.
3. Coordinate client’s care with primary care providers, specialists, behavioral health providers, Long Term Services and Supports providers, public services, community providers, and vendors as necessary and appropriate to assist member to achieve and maintain optimal level of functional independence to reside in the most appropriate level of care.
4. Conduct, review, and document comprehensive needs assessments and share with other care team members as necessary
5. Provide guidance, education and referrals to help clients seek solutions to specific social, cultural, or financial problems that impact their ability to manage their health care needs and retain housing.
6. Provides communication support and acts as Member advocate on issues of access and use of primary care and prevention services.
7. Conduct in-person interviews and ongoing interactions with residents/members to assist in gathering information on their self-care ability, knowledge and adherence and challenges or risks related to housing retention.
8. Establish ongoing primary care or achieve other improvements in health related activities.
9. Maintain case files by ensuring that they are documented timely in accordance with SCFHP policies and procedures, state and federal requirements and organized in a manner that adheres to standards for audit requirements.
10. Ensure the privacy and security of PHI (Protected Health Information).
11. Share related information about client’s physical and mental health conditions to client’s interdisciplinary care team
12. Maintain knowledge of current resources in Santa Clara County to support care coordination
13. Develop effective and professional working relationships with internal and external stakeholders and partners.
14. Identify issues and trends (data, systems, member or provider or other) as well as general departmental questions/concerns and report relevant information to management and make recommendations to improve operation
15. Collaborate with SCFHP team members on cross-departmental improvement efforts, organizational and departmental objectives, quality improvement projects, optimization of utilization management, and improvement of member satisfaction.
16. Attend and actively participate in Health Services meetings, operational meetings, training and coaching sessions, including off-site meetings as needed.
17. Perform other duties as required or assigned.

REQUIREMENTS – Required (R) Desired (D)
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. High School diploma (R)
2. Bachelor’s Degree in a health-related or social services field or equivalent experience, training or coursework (D)
3. Minimum two years of experience in Community Outreach or case coordination. (R)
4. Knowledge of social case management and conflict resolution. (D)
5. Knowledge of long-term services and supports, behavioral health and/or relevant public services and community resources. (R)
6. Strong organization and time-management skills (R)
7. Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)
8. Vietnamese, Chinese, Tagalog or Spanish language bi-lingual skills. (D)
9. Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities). (D)
10. Ability to work within an interdisciplinary team structure. (R)
11. Travel to off-site locations for work such as in office, housing site, facility, clinic, and other community settings. (R)
12. Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
13. Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R)
14. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R)
15. Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
16. Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing as mandated by social work scope of practice. (R)
17. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
18. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
19. Ability to maintain confidentiality. (R)
20. Ability to comply with all SCFHP policies and procedures. (R)
21. Ability to perform the job safely and with respect to others, to property and to individual safety. (R)

WORKING CONDITIONS
Generally, duties are primarily performed in an off-site housing environment . Incumbents are subject to frequent contact with clients, housing co-workers, 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:

1. 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)
2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
3. 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)
4. 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)
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
6. 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.