AmeriHealth Caritas Community Health Navigator in Philadelphia, Pennsylvania
Community Health Navigator
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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
The Community Health Navigator is part of a team that locates and engages difficult-to-access members. These associates live and work in targeted geographic areas of the area where the there is a high number of chronically ill members with whom we struggle to maintain contact. The team acts as a Plan’s/LOB’s “feet on the street,” making outreach visits to members’ homes when traditional outreach has failed to establish contact with the members by phone or mail. This position is responsible, establishing and cultivating relationships with community stakeholders and providers, and engaging a group of select members as assigned by an assigned territory. As experience is garnered and as appropriate, this position may support Medical Affairs initiatives and be assigned to them by initiative.
- Conducts home visits with Plan members as assigned by initiative.
- Informs members of the required actions to fulfill HEDIS, EPSDT, and Plan requirements and other referred outreach, through home visits, and encourages them to comply.
- Schedules and confirms member appointments with their PCP and refers internally for transportation support as needed.
- Refers members that need sustained attention to Case Management department.
- Calls PCP offices to confirm recently scheduled appointments.
- Works with Provider Network Management department to cultivate relationships with provider offices.
- Assists in addressing members’ barriers to care and to encourage/foster relationships with their PCP.
- Documents all member encounters/home visit outcomes in MS Excel spreadsheets and when supporting Medical management initiatives, via the JIVA Medical Transition Checklist; shares with supervisor on weekly basis.
- Refers members to community resources as needed; provides preliminary health education based on member conditions.
- Documents environmental assessment of member’s home conditions (refers to Case Management as necessary)
- Maintains flexible work schedule; able to support Public Affairs and Marketing community events as required.
- As competency is mastered, this position may also provide support to Medical management, such as:
- Engages unable to reach Plan members based on the following Medical Affairs initiatives: Medication Adherence, Hospital Re-admittance, Pre-Natal, Intensive Case Management.
- Verifies and updates member information in JIVA/Streamline (or other appropriate systems).
- Completes Medical Transition Checklist in JIVA while in the member’s home.
- Facilitates warm transfer between member and Case Management/Rapid Response Outreach Team.
- High School/GED.
- Associate’s Degree in Health Care, Human Services or a related field or equivalent work experience preferred.
- Candidate must possess a valid driver’s license and be willing and able to drive a car.
- Minimum of two years of health care experience and/or experience working in low income communities.
- Community based outreach experience required; knowledge of Plan’s community’s geography preferred.
- Previous experience in presenting health education materials to individuals and families.
- Some knowledge of medical terminology and disease processes.
- Some to proficient knowledge of Medicaid requirements and plan, policies and procedures.
- Some to strong knowledge of managed care.
- Computer skills required (Microsoft Word, Excel, JIVA, Internet Explorer, Streamline)
- Some to strong data entry skills required.
- Ability to work in the field during inclement weather.
- Proven ability to diffuse difficult or confrontational situations.
- Ability to navigate complex situations while in the field.
EOE Minorities/Females/Protected Veterans/Disabled