Care Navigator; CMA​/LPN - Battle Creek, Michigan

Overview

Homeward is rearchitecting the delivery of health and care in partnership with communities everywhere, starting in rural America. Today, 60 million Americans living in rural communities are facing a crisis of access to care. In the U.S. healthcare system, rural Americans experience significantly poorer clinical outcomes. This trend is rapidly accelerating as rural hospitals close and physician shortages increase, exacerbating health disparities.

In fact, Americans living in rural communities suffer a mortality rate 23 percent higher than those in urban communities, in part because of the lack of access to quality care.

Our vision is care that enables everyone to achieve their best health. We’re creating a new healthcare delivery model that is purpose-built for rural America and directly addresses the issues that have historically limited access and quality. Homeward supports Medicare-eligible beneficiaries by partnering with health plans, providers, and communities to align incentives – taking full financial accountability for clinical outcomes and the total cost of care across rural counties.

As a public benefit corporation and Certified B Corp™, Homeward’s mission and business model are aligned to address the healthcare, economic, and demographic challenges that make it challenging for rural Americans to stay healthy. Our Homeward Navigation™ platform uses advanced analytics to connect members to the right care and local resources that address social determinants of health and improve holistic health outcomes.

Since many rural communities lack adequate clinical capacity, Homeward also employs care teams that supplement local practices and reach people who cannot otherwise access care. Homeward is co-founded by a leadership team that defined and delivered Livongo’s products, and backed most recently by a $50 million series B co-led by Arch Ventures and Human Capital, with participation from General Catalyst for a total of $70 million in funding.

With this leadership team and funding, Homeward is committed to bringing high-quality healthcare to rural communities in need.

The Opportunity

We seek a full-time Care Navigator passionate about helping people in rural communities in the Battle Creek | Charlotte area.

• Work with Homeward members and their providers to achieve their best health. Conduct proactive telephonic, video, and in-person outreach to build relationships, connect them with services they need—medical, behavioral, and social—and address gaps in care.
• Understand local community needs and use expertise to advance members’ health.
• Support fulfillment of recommended health services, including obtaining prescribed medicines, coordinating scheduling of health-related activities, attending scheduled health-related appointments, and testing.
• Mitigate administrative and logistical barriers to obtaining recommended health services.
• Attend regular staff meetings, trainings, and other meetings as requested.
• Document all member encounters in the designated electronic platform in a timely manner, including records of navigation activities, clinical service plans, and outcomes achieved by the member.
• Engage potential members by effectively communicating the services and value that Homeward can provide.
• Build member health literacy and digital literacy.
• Initiate communication with patients on completing pre-appointment requirements (e.g., registration forms, lab tests, x-rays).
• Prepare for visits by coordinating patient flow, gathering and documenting pertinent data (vitals, medications, allergies) from the patient, and entering information into the medical record.
• Conduct check-ins and/or visits with members telephonically, virtually, in-clinic, and/or in-home regularly.
• Maintain a member panel of seniors located within a specific set of counties and support completion of care plans and health goals.
• Provide coaching to activate members in their self-care and reduce adverse social isolation by connecting to community networks.
• Collaborate with members’ primary care providers and teams to ensure cohesive care.
• Build for scale by identifying and maintaining a list of community resources and…