Community Health Navigator

Amerihealth Caritas•Muhlenberg Township, PA

1d•Remote

About The Position

The Community Health Navigator engages members through outreach and in-person visits to identify and address Social Determinants of Health needs, improve access to healthcare services, and help members navigate benefits and community resources. The role promotes preventive care, reduces barriers to care, and connects members with programs that support their health and well-being. This is a remote/field-based role serving Pennsylvania counties. Approximately 95% of the work involves travel throughout Berks, Lehigh, Lancaster, Delaware, and Chester counties to meet members in hospitals, homes, or community locations. The position includes member outreach and education, coordination with care teams and community organizations, and support for members transitioning from nursing facilities into the community.

Requirements

At least two years of healthcare experience in an office, clinic, or hospital setting, or human services experience.
Valid driver's license, car insurance, and reliable transportation.
Ability to travel approximately 95% of the time throughout the counties served.
Physical ability to perform duties involving prolonged standing, sitting, and activities such as lifting educational materials, premium giveaways, and household items for setup.
Ability to collaborate with people in a variety of roles.
Ability to stay focused and organized while managing multiple deadlines.
Ability to handle confidential or time-sensitive information carefully.

Nice To Haves

Associate’s degree in healthcare, human services, or a related field, or equivalent work experience in behavioral health or substance abuse.
Bachelor’s degree.
Community-based care experience.
Knowledge of Medicaid requirements, health plan policies and procedures, and managed care.
Knowledge of and experience working with vulnerable populations.
Knowledge of and experience with substance use disorder and behavioral health.
Experience locating housing.
Strong growth mindset and ability to learn from setbacks.

Responsibilities

Develop and maintain relationships with community organizations through phone, mail, email, and personal visits.
Collaborate with internal departments and external agencies to obtain information relevant to health education and promotion programs.
Educate members and their representatives about nursing facility transitions and available benefits.
Connect with Long-Term Services and Supports members who have been difficult to reach through unannounced home visits and outreach calls.
Coordinate basic care follow-up tasks and collaborate with case management teams, community-based healthcare providers, and other organizations.
Contact members to identify barriers and unmet needs.
Explain actions members need to take to fulfill HEDIS, EPSDT, plan, and other outreach requirements, and encourage compliance by phone or home visits.
Help members address barriers to care and build relationships with medical and dental providers.
Coordinate with Primary Care Physicians to obtain Comprehensive Medical Reports for annual redeterminations.
Help members obtain community resources and durable medical equipment.
Conduct in-facility assessments for Long-Term Services and Supports members interested in leaving a nursing facility.
Support transitions from nursing facilities to the community, including helping members obtain vital documents, shop for approved household items, and set up those items.
Conduct initial telephone outreach to new members and serve as backup to personal care coordinators.
Complete tasks assigned by the Long-Term Services and Supports management team to support members.
Document member contacts in the case management system.