Clinical – Care Navigator – J01009 Care Navigator – J01009 Position Available In [Unknown county], South Carolina

Clinical

• Care Navigator
• J01009 Care Navigator
• J01009#25-62208
  Various, SC
  All On-site Job Description

Job Description:

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.

Education/Experience:

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.

License/Certification:

Current state’s clinical license preferred
For Illinois YouthCare Plan only:

Education/Experience:

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.
For Illinois YouthCare 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. Will be available during regular work hours to communicate with and to provide education and training to DCFS staff and stakeholders regarding managed care, and to engage in immediate problem resolution with Contractor’s administrative staff. Will ensure that issues or barriers reported to a liaison must be addressed and the resolution communicated to appropriate DCFS staff or stakeholder. For Health Net Federal Services only: Licensed Bachelor’s or Master’s Prepared Social Worker; LSW, LCSW, LICSW, or LMSW required For Nevada SilverSummit (Medicaid)

Healthplan:

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. required

Responsibilities:

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.
Comments for

Vendors:

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of

• Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.” =====
  Centene Job Description Story Behind the Need
• Business Group & Key Projects Health plan or business unit
  Team culture
  Surrounding team & key projects
  Purpose of this team
  Reason for the request
  Motivators for this need
  Any additional upcoming hiring needs?

This is a new line of business from the state managing Medicaid Seriously Mentally Ill (SMI) members from ages 6-64 years of age. Members require at least 1 phone call monthly, 1 visit every 90 days and an annual assessment. Case Navigators are allowed a of caseload of no more than 60 members due to the intensive nature of the members. Purpose of plan to assure members are receiving all medications, attending all MD/ mental health clinic appts, have adequate housing and transportation to attend all appts.
This project has a go live date of 7/1/25. Since there is a cap on the amount of cases a CN can have we anticipate ongoing hiring needs. CN are responsible for the unable to locate population and will be conducting all research necessary to locate the members.
Typical Day in the Role Daily schedule & OT expectations
Typical task breakdown and rhythm
Interaction level with team
Work environment description Schedule of 8 hours daily. CN will make calls, visits and coordinate care for members. Our work is driven by metrics from the state that all are time driven. We currently have 12 CNs. They will be issued a company owned computer and cellphone. The team interacts with one another thru Teams, calls or texts. All team members have “buddies” that also work in the same area and are available for co-visits.
Compelling Story & Candidate Value Proposition What makes this role interesting?
Points about team culture
Competitive market comparison
Unique selling points
Value added or experience gained Able to set your own daily schedule. It is a new line of business from the state. Growth for the company will bring added positions for upward movement. Ability to help at risk youth. Work with parents and children to achieve best outcomes. Will visit mental health facilities if members are located there and residential homes throughout the state. Must be able to travel in your own vehicle for visits.
Candidate Requirements
Education/Certification

Required:

Bachelor’s Degree , etc.

Preferred:

Certified Community Health Worker/
Licensure

Required:

Preferred:

Years of experience required
Disqualifiers
Best vs. average
Performance indicators Must haves: Bachelor’s Degree Nice to haves: A background in Behavioral Health (BH) is helpful.

Disqualifiers:

Unwilling to do blind visit. Must be willing to travel.

Performance indicators:

Able to meet strict deadlines related to documentation/visits/calls Best vs.

average:

Top 3 must-have hard skills
Level of experience with each
Stack-ranked by importance
Candidate Review & Selection 1 Ability to handle frequent change in policies and procedures
2 Work independently to meet metrics
3 Team collaboration
Candidate Review & Selection Shortlisting process
Second touchpoint for feedback
Interview Information

Onboard Process and Expectations Projected HM Candidate Review Date:

There are deadlines for enrolling new employees in courses. Can discuss at meeting

Number and Type of Interviews:

1 Teams or Zoom interview
Extra Interview Prep for

Candidate:

N/A
Required Testing or Assessment (by Vendor): N/A
Manager Communication Preferences & Steps Background Check Requirements (List DFPS or other specialty checks here) Motor Vehicle Record from the DMV Do you have any upcoming PTO? 6/20 and 7/4 Colleagues to cc/delegate Annette Brown (COS)