Transition Navigator- Fresno

Overview

Description

Location: Fresno, CA (Onsite)

Classification: Full-Time

This position is non-exempt and will be paid on an hourly basis.

Schedule: Monday-Friday 8am-5pm

Benefits:

• Medical
• Dental
• Vision
• Paid Time Off (PTO)
• Floating Holiday
• Simple IRA Plan with a 3% Employer Contribution
• Employer Paid Life Insurance
• Employee Assistance Program

Compensation:

The initial pay range for this position upon commencement of employment is projected to fall between $20.50 and $25.62. However, the offered base pay may be subject to adjustments based on various individualized factors, such as the candidate's relevant knowledge, skills, and experience. We believe that exceptional talent deserves exceptional rewards. As a committed and forward-thinking organization, we offer competitive compensation packages designed to attract and retain top candidates like you.

Job Duties and Responsibilities:

• Conduct outreach and enrollment activities, including performing both in-person and on the phone outreach to eligible and existing members to promote program enrollment.
• Educate members on ECM Program benefits and services to promote program enrollment.
• Verbalizes program enrollment benefits in a clear and engaging manner, leading to increased member enrollment.
• Completes member questionnaires or assessments and consistently document care management activities and encounters in the CM System, per program protocol.
• Works collaboratively and assists clinical and social services Case Managers with care coordination, member follow-up, communication with appropriate agencies and preparation and distribution of documents and/or reports.
• Works collaboratively and assists the Clinical or Social Services Case Managers to manage members in need of Transitional Care Services (TCS).
• Gather clinical information and assist with coordinating post-discharge services, including scheduling provider appointments or transition of care clinic appointment, ensuring post-discharge referrals are received by the member, transportation to appointments is arranged, and members are aware of follow-care needs.
• Proactively initiates care transition coordination with referral sources and internal partners to ensure seamless patient transitions to home or community.
• Reports on variances and issues to nursing or social services staff assigned to the members.
• Assists members with appointment scheduling, transportation, referral coordination, and other enhanced care coordination services.
• Responsible for gathering clinical information from outside sources such as PCPs, specialists and other providers, electronic health records, and other partnering entities.
• Verifies member eligibility, demographic information, and benefits.
• Assists in maintaining the integrity of the data systems by entering information into department’s data systems.
• Provides general Office administration duties including answering phones. Provides general customer service to all potential and exiting ECM members and partnering agencies.
• Gathers relevant information for the identified member population during assessment, care planning, interdisciplinary care team meetings, and transitions of care.
• Outreaches to members to verify that needs are being met and services are being delivered.
• Intervenes at the member level to coordinate the delivery of direct services to the members and their families.
• Serves as an associate and resource to members, providers, staff, and external customers regarding policies, benefits, and care coordination.
• Gather information, present, and participate in Interdisciplinary Care Team (ICT) meetings, and communicate the member’s needs and preferences in a timely manner to the member’s multi-disciplinary care team.
• Attend mandatory departmental and staff meetings.
• Assist with training and orientation of new staff.
• May be assigned to conduct in-person meetings with members during clinic visits.
• Assist case management team with oral interpretation, as applicable.
• Performs other duties as assigned

• Education: High School diploma or GED required.
• Experience working in a health care or community health setting is preferred.
• Knowledge of prior authorization or case management regulations governing Medi-Cal, Commercial, Medicare, CCS, and other government and commercial programs preferred.
• Experience in a managed health care environment preferred (IPA, HMO, or Health Plan).
• Medical Assistant or Community Health Worker certification preferred.
• Possession of Community Health Workers (CHW) Certificate OR completion of CHW Certification within one year of acknowledging this job description.
• Demonstrated experience working with one or more of the ECM populations of focus, including but not limited to: adults and children experiencing homelessness, those with serious mental illness (SMI) or substance use disorders (SUD), high-utilizers of healthcare services, adults or children with complex physical, behavioral, or developmental conditions, individuals transitioning from incarceration,…