Program Support Navigator Position Available In Wake, North Carolina

Program Support Navigator 3.8 3.8 out of 5 stars 110 Donmoor Court, Garner, NC 27529 This position is a primarily remote position. The Program Support Navigator position is a non-clinical role that works with the Healthy Opportunities staff to support the multi-disciplinary team approach of patient care and other organizational mandates as designated. Coordinators may directly help members improve their health outcomes through resource linkages and regular follow-up. The Program Support Navigator will be responsible for working with special programs and initiatives that will require access to and documenting in additional documentation systems associated with Pilots, Special Programs, or Initiatives; will be responsible to carry a primary caseload of members to provide care coordination activities, supporting and connecting members referred for services under the special program/initiative to the appropriate assistance as available. The Program Support Navigator will document in the member’s Community Care of North Carolina’s (CCNC) record and the special program documentation system as required. Essential Functions Function as Primary Advocate for members with Social Determinants of Health needs. Support members for long lengths of time without turnover of caseload Serve as the primary contact for the members with the Pre- Paid Health Plans (PHPs) and the Human Service Organizations (HSO). Receive and process all referrals from various sources related to Social Determinants of Heath (SDOH) needs. Efficiently and effectively review all referral resources such as queues/ emails/ fax/phone numbers/ lists identified for the program in a timely manner. Conduct interviews with members for eligibility review Verification of eligibility by utilization of appropriate screenings Verification of demographic information in the Care Management documentation platform and the program documentation system. Utilize the program documentation system to follow required processes related to the pilot. Complete the Pilot Eligibility Service Assessment (PESA) in the program documentation system and the Service Authorization in the program documentation system. Utilize

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to complete referral(s) daily to the appropriate HSO(s). Adhere to pilot standards for completion of appropriate screenings with initial assessment screening and follow up screenings. Utilize the pilot standards to complete service mix reviews at 3 months, 9 months, etc. and utilize the appropriate screening tools. Utilize the pilot standards to complete eligibility reassessment every 6 months utilizing the appropriate screening tools. Identify barriers to referred services, intervene as necessary on behalf of the members between the HSOs and PHPs. Proficient in utilization of CCNCs Care Management Platform Assist with mailing educational materials, consent forms or other documents to the member, as necessary. Assist with referrals on behalf of and/or task delegated by the Care Management or program team. Provide information for access and coordination of resources. Assist member with care coordination and HSO navigation. Provide culturally appropriate health education and information. Provide general education and social support. Screen and identify clinical needs and refer to the HOP Clinical Care Management Team as needed. Conduct updates to the PESA with any change in member status is required. Appropriate use of necessary communication methods is expected with the members, HSOs, PHPs and the Network Leads based upon member’s needs. Demonstrate proficiency with creation of the care plan and update with each contact and at a minimum of every 3 months. Access multiple EHRs (electronic health records) to obtain and upload documents into the care management platform as needed while maintaining all HIPAA guidance and confidentiality. Complete transition of care in program documentation platform when the member changes PHPs or changes PCPs to a non-CCPN provider. Access to Hospital/Data or the Electronic Medical Record system will be required, as necessary. Meet monthly productivity and role expectations. Expectation of a minimum caseload will be required for this role. Professional Collaboration with the PHP, HSOs, Network Leads and the clinical HOP Care Team to address barriers and create efficiencies with processes frequently. Fields multiple calls daily from members, PHPs and HSOs. Addresses multiple emails from program documentation system from PHPs and HSOs. Receives complaints and concerns from members routinely regarding services or barriers to service delivery. Report concerns and issues to the PHPs and Network Leads as applicable. Disenrollment of members when appropriate. Adhere to CCNC Privacy and Security policies to ensure that patient and company data is properly safeguarded. Abide by department guidelines, company policies, and HIPAA regulations Adhere to HOP Program Specific trainings, job aids and policies as well as fee schedules and admin fees for services. Adhere to program specific time requirements for outreach, follow up, etc. Attend Departmental and corporate meetings, local and regional trainings, and required trainings, quality improvement activities, community meetings related to the special program/initiative. Attend monthly meetings with Network Leads, DHHS and other program specific meetings as required. Understand and uphold CCNC goals, objectives, and standards. Remain educated and current on all program processes/ documentation requirements and workflows. Follows all program requirements and processes. Perform all other duties as requested. Qualifications High school diploma or GED required, or Licensed Practical Nurse 2-4 years working as a member care coordinator or similar role preferred. 4-year minimum experience in a health care setting required. 2 or 4-year degree in health-related field preferred Bilingual preferred Knowledge, Skills, and Abilities Knowledge of and experience working in patient or clinical data systems Computer skills required including various office software and the internet; experience with MS Office software preferred. Knowledge of state and federal benefits system Excellent communication and customer service skills – oral and written. Proficient Motivational Interviewing skills Organizational and time management skills Ability to prioritize and demonstrate flexibility in day-to-day functions. Ability to work in a high demand role due to multiple calls daily. Sensitivity to diversity of cultures, language barriers, health literacy and educational levels Knowledge of medical terminology Ability to respond to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives. Able to shift strategy or approach in response to the demands of a situation. Working Conditions The job environment is primarily an office or home environment. Multiple contacts are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office, community, and household conditions, as well as communicable disease could occur. Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time. Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices. Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds. The job environment can be intense as high volume, repetitive work is an expectation.