Clinical - Care Navigator - J01009

Job Profile Summary

Position

Purpose:

Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.

Requires a Bachelor’s degree and 2 – 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. For Illinois Youth Care Plan only:
Bachelor's degree in Social Work, Nursing, Health Behavioral Science or equivalent experience. 2+ years of experience working within a social service agency and/or advocacy environment. Must reside in Illinois.

Current state’s clinical license preferred. For Illinois Youth Care Plan only:
Education/

Experience:

Bachelor's degree in Social Work, Nursing, Health Behavioral Science or equivalent experience. Must reside in Illinois. For Illinois Youth Care Plan Foster Care Liaison Roles only:
Will be stationed on-site and hosted by DCFS Regional Offices throughout the State to provide administrative coordination with DCFS staff and stakeholders, available during regular work hours. For Health Net Federal Services only:
Licensed Bachelor's or Master's Prepared Social Worker; LSW, LCSW, LICSW, or LMSW required. For Nevada Silver Summit (Medicaid) Health plan:
Licensed Bachelor's or Master's Prepared Social Worker: LSW or LMSW required. For Mississippi Magnolia Health plan:
Bachelor’s or Master’s degree in a healthcare related field (social work, sociology, psychology, public health) and 2 – 4 years of related experience; LSW,LMSW preferred. For CMS Florida licensed practical nurse with a minimum of four years of pediatric experience, or a Master’s degree in social work with a minimum of one year of related professional pediatric care experience. May require up to 80% local travel.

• Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome
• Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care
• Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care based on service assessment and plans
• Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner
• May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal and third-party payer regulators
• May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate
• May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits
• Other duties or responsibilities as assigned by people leader to meet the member and/or business needs; performs other duties as assigned
• Complies with all policies and standards

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.