Community Health Navigator - II

Medzed LLC•San Leandro, CA

18d•Hybrid

About The Position

MedZed is a leader in delivering value-based, technology-enabled social support to a diverse population of high-cost Medicaid members who have been unreachable with telephonic outreach, disconnected from primary care, and using hospital-based services as their primary point of care. We combine innovative technologies with field-based outreach to find and engage these members. We then apply a model of care designed to re-connect them to primary care, address the Health-Related Social Needs (HRSNs) that contribute to their disengagement and present barriers to care, and provide them with the means and knowledge to take more control over their healthcare. Our interventions yield reduced Emergency Department and Inpatient utilization costs for our health plan partners and improved quality of life for their members. THE COMMUNITY HEALTH NAVIGATOR II (CHN II) IS AN ECM CARE MANAGER RESPONSIBLE FOR MANAGING COMPLEX AND HIGH-ACUITY MEMBER CASES, SERVING AS A MENTOR TO NEWLY HIRED CARE TEAM STAFF, AND MODELING EXCELLENCE IN ENGAGEMENT, DOCUMENTATION, AND COMPLIANCE PERFORMANCE. THE CHN II ROLE IS FOCUSED ON DEVELOPING FOUNDATIONAL CARE COORDINATION SKILLS. CHN IIS ARE RESPONSIBLE FOR OUTREACH (VIA DOOR KNOCKS AND TELEPHONE), ASSESSMENTS, QUALITY AND BILLABLE CARE DELIVERY AND MEMBER GRADUATIONS IN COMPLIANCE WITH CALAIM, DHCS, AND CONTRACTED HEALTH PLAN REQUIREMENTS.

Requirements

High School Diploma or equivalent required
2+ years’ experience in ECM, case management, or community health
Demonstrated excellence in documentation and compliance.
Ability to manage complex psychosocial and medical needs.
Curious and relentless nature
Commitment to do outreach via phone and in-person to enroll new members.

Responsibilities

Manage an ECM caseload up to 55+ members.
Complete initial and follow-up ECM assessments including Primary, Secondary, PHQ-9, and required reassessments.
Support development and updates of individualized Care Plans
Calls, field visits, and door knock to provide care and enroll new members.
Build and maintain a member panel through consistent outreach.
Coordinate referrals to health plans, providers, and community-based resources.
Staff tables and other community partnership opportunities as requested.
Document timely, accurate, and compliant case notes in Salesforce Health Cloud and health plan portals, as necessary.
Participate in interdisciplinary case conferences and team huddles
Escalate complex or high-risk member needs appropriately.
Maintain compliance with CalAIM, DHCS, and health plan requirements.
Meet outreach, engagement, and documentation standards.
Attend required training and professional development.
Support audit readiness and data tracking activities.
Comply with all company policies and administrative requirements