Navigator, Medicaid Member

Company: HealthEcareers - Client
Location: Clackamas
Posted on: September 3, 2024

Job Description:

Job Summary:
The Medicaid Member Navigator primarily aids newly enrolled individuals and their families to successfully access health care services within Kaiser Permanente, and to assist members in accessing non-KP services within the community at large. Further duties include, on-going support to ENCC clinical staff concerning a variety of OHP eligibility research issues, as well as providing non-clinical member support designed to address complex socio-economic needs impacting member health and health care. Navigators coordinate and support various department specific projects and programs as directed. They also connect members to vetted community agencies and resources for support and assistance with various needs. Navigators are highly trained communicators and subject matter experts, utilizing Motivational Interviewing to deliver ongoing community resource knowledge. Navigators collaborate extensively within the KP system and larger community to overcome logistical barriers and increase care quality, improve care continuity, and reduce care costs.
Essential Responsibilities:

• Orientation: Provides orientation to the KP integrated care system and PCP model for all new Kaiser Medicaid members. Orientation includes but is not limited to; available KP and external resources such as the KP Nurse Advice Line, Exceptional Needs Program, dental and mental health care, transportation and translator services. Verifies that members have received their ID, ordering cards as needed. Educates member to the role of the PCP and the appropriate use of health care resources.
• Through the use of a telephonic screening process, Navigators identify members that have unmet needs or active concerns. This may include ethnic or language considerations, social needs, chronic diseases including mental health, disabilities and/or current pregnancy. Additionally, support is provided through PCP selection and assignment, appointment scheduling, medication transfers between health systems, and active collaboration to connect members to appropriate community resources based on any disclosed social needs.
• Coordination and Collaboration: Develop relationships with community agencies and relevant healthcare programs to gain and maintain expertise in the roles, capabilities, and capacities of those agencies.
• Develop collaborative relationships with staff across departments within KP and externally with the aim to promote cohesion between multi-system units. Participate in on-site events, clinics, and outreach initiatives as assigned.
• Actively develop, coordinate and support various departmental projects and programs (e.g. DHS Metric, Medi-Medi care coordination Flexible Funds administration, Bariatric Services, PRNC) in collaboration with internal and external stakeholders.
• Participate in and consult with inter-disciplinary care teams to support complex members who have resource needs or logistical barriers. Address community resource needs for complex members/families in collaboration with interdisciplinary team
• Insurance: Perform all necessary functions, including the usage of internal and external eligibility databases, to ensure member coverages are appropriately assigned and maintained. Where necessary, document and communicate coverage discrepancies to relevant parties.
• Documentation and Communication: Respond to referrals from various departments and locations to support members with economic, logistical, and other non-clinical barriers to care. Outreach and document findings related to member needs; connect member needs to appropriate resources; finally, perform follow up to determine if need is met. Escalate to and collaborate with clinical colleagues and care teams as appropriate. Refer member cases for Exceptional Needs Care Coordination (ENCC) for assistance and guidance when complex issues or concerns are identified. As directed by RN and/or SW, make necessary arrangements and referrals to internal for external resources. Navigators communicate findings and actions to the PCP or other providers to assist members with care coordination. Through population review, Navigators outreach to members for follow-up and assistance related to ED usage, missed appointments or other conditions which present as obstacles to care
• Documentation and Communication: Provides general administrative support to the Medicaid program through recordkeeping, scheduling meetings and filing as requested. Basic Qualifications: Experience
  • Minimum two (2) years of experience with health-related customer service, medical office practice or other patient-related experience in the ambulatory setting. Education
    • Bachelors degree (the following may substitute: Associate degree in a social service- or healthcare-related field with an additional two (2) years of directly related field. License, Certification, Registration
      • N/A Additional Requirements:
        • Competent computer skills with proficiency in Microsoft Office products and ability to learn new technical skills
        • Ability to demonstrate flexibility and to adapt when faced with internal or external barriers, or when faced with differing points of view
        • Ability to anticipate next steps, be proactive and collaborate with coworkers and stakeholders
        • Ability to use integrated technology platforms and virtual care coordination tools
        • Ability to use good judgment and problem-solving skills, able to effectively respond to difficult situations and resolve conflicts
        • Ability to work independently in a fast-paced environment
        • Excellent written and verbal communication skills
        • Ability to complete Motivational Interviewing Certification and additional certifications or trainings as assigned
        • Ability to organize and prioritize workload; effective time and task management skills in achieving program initiatives and priorities
        • Ability to successfully complete tasks with little or no supervision.
        • Ability to anticipate patient and team member needs Preferred Qualifications:
          • Minimum three (3) years of experience in health-related customer service, medical office practice or other patient-related experience in the ambulatory setting.
          • Experience with outreach programs.
          • Bachelors or Masters degree in a business- or healthcare-

Keywords: HealthEcareers - Client, Portland , Navigator, Medicaid Member, Other , Clackamas, Oregon