Insurance Navigator/Medicaid Redetermination

FAMILY HEALTH CARE CENTER OF KALAMAZOO•Kalamazoo, MI

25d

About The Position

The Insurance Navigator / Medicaid Redetermination Specialist supports continuity of care for Family Health Center patients by providing insurance navigation, eligibility assistance, and Medicaid redetermination support. The position helps patients and families understand and maintain health coverage, reduces coverage gaps, and collaborates with clinical, financial, and community partners on Medicaid redetermination, Marketplace enrollment, and other public insurance programs. The role emphasizes health equity, cultural humility, and patient advocacy. The Navigator collaborates with financial counselors, community health workers, and customer experience technicians to coordinate enrollment in Medicaid or Marketplace coverage, gather documentation for enrollment and redetermination, and help patients maintain adequate coverage and access to Family Health Center services. The position also evaluates coverage options to support patients’ oral health outcomes and participates in outreach with local churches, community and civic organizations, housing complexes, school systems, and other organizations in the Kalamazoo service area. Work is performed both in the community and at a health center location, with contact with patients and staff. The role may involve a fast-paced clinical setting, emergency situations, and irregular hours. Reliable transportation and a valid driver’s license are required for travel to assigned locations.

Requirements

At least 1–2 years of experience in community mobilization, outreach, insurance navigation, Medicaid eligibility, patient access, or social services is preferred.
Strong interpersonal, communication, and organizational skills.
Ability to work effectively with diverse populations and demonstrate cultural humility.
Viewed as a trusted member of the community.
Demonstrated customer-focused interpersonal skills when working with practitioners, interdisciplinary healthcare teams, community agencies, and patients and families with diverse opinions, values, religious beliefs, and cultural beliefs.
Excellent written, verbal, and listening skills.
Positive relationship-building and critical-analysis skills.
Ability to work autonomously and be accountable for practice.
Ability to influence and negotiate individual and group decisions.
Ability to function in a fluid, dynamic, changing environment.
Reliable transportation and a valid driver’s license to travel to office locations or other assigned locations.

Nice To Haves

Proficiency with electronic health records and state eligibility systems.
Bilingual or multilingual skills.
Certified Application Counselor (CAC) certification, or willingness to obtain it within a specified timeframe.
Experience working in a federally qualified health center, social services, or a safety-net environment.

Responsibilities

Serve as the primary point of contact for patients undergoing Medicaid redetermination and support timely completion and submission of renewal applications.
Identify patients at risk of losing Medicaid coverage and conduct outreach by phone, mail, text, or in person.
Help patients complete Medicaid renewal forms, provide required documentation, and navigate state eligibility systems.
Educate patients about renewal timelines, eligibility requirements, and possible redetermination outcomes.
Track renewal status and follow up to prevent coverage lapses.
Assist with enrollment in Medicaid, CHIP, and Affordable Care Act Marketplace plans when Medicaid eligibility changes.
Support transitions between coverage types and explain plan benefits, costs, and provider networks.
Help uninsured or underinsured patients identify appropriate coverage options and financial assistance programs.
Maintain Certified Application Counselor (CAC) certification or equivalent, as required.
Provide culturally responsive education about insurance benefits, patient rights, and responsibilities.
Advocate for patients with state Medicaid offices, Managed Care Organizations, and insurance carriers when appropriate.
Support patients experiencing language, literacy, or technology barriers to enrollment and redetermination.
Partner with clinical staff, care coordinators, case managers, and billing teams to align insurance coverage with care delivery.
Participate in interdisciplinary team meetings to identify patients with coverage-related barriers to care.
Coordinate with community organizations and state agencies to support patient access to coverage.
Document patient interactions, applications, and outcomes accurately in the electronic health record and eligibility systems.
Track performance indicators related to Medicaid retention, coverage continuity, and successful renewals.
Comply with HRSA, CMS, and state Medicaid requirements, including privacy and confidentiality standards.
Support audits, grant reporting, and quality improvement initiatives related to insurance coverage and access to care.
Participate in community outreach initiatives and engage with local churches, community and civic organizations, housing complexes, school systems, and other organizations.
Perform other duties as assigned.