PACE Participant Navigator (PPN)

INNOVATIVE INTEGRATED HEALTH•Anaheim, CA

4d•$17 - $22

About The Position

Under the direction of the Participant Relations Navigator, the PACE Participant Navigator (PPN) is responsible for answering a high volume of inbound calls and inquiries in a timely manner. Provides oversight of all communications coming into PACE from assigned participants and their caregivers in the form of phone calls, email, fax, letters, and in-person inquiries. Timely responses to all participant communications are essential. Must effectively prioritize workloads as new communication and tasks are submitted. Identify the participants’ needs, clarify information, research issues, and provide solutions or alternatives whenever possible. Accurately and consistently document all conversations in the electronic database. This position is a liaison between the participant, Interdisciplinary Team (IDT) members, social work, RN case management and other PACE departments to resolve issues and ensure participant satisfaction.

Requirements

Bilingual Korean or Vietnamese
Working knowledge of physical, mental, spiritual, and social needs of the frail elderly and their families.
Effective management skills.
Ability to work with ethnically diverse populations.
Ability to apply creative problem-solving skills to the complex issues.
Ability to work with interdisciplinary teams.
Strong organizational skills, flexible, resourceful, and energetic.
Effective oral and written communication skills.
Valid Driver’s license
Automobile insurance verification
Ability to engage in local travel
Is medically cleared form communicable diseases and has all immunizations up-to-date before engaging in direct participant contact
Minimum of one (1) of documented experience working with a frail or elderly population.
Is medically cleared of communicable diseases and has all immunizations up-to-date before engaging in direct participant contact.

Nice To Haves

Experience as a Community Health Worker or similar training preferred.

Responsibilities

Answer incoming calls, emails, and in-person requests for assistance in a timely manner in accordance with departmental performance targets and provide excellent customer service while doing so. May include assisting members in the PACE day center or clinic.
Accurately and consistently document any expression of dissatisfaction, formal grievances or Service Delivery Requests and forward to the appropriate department for processing.
Interface with Quality Improvement, Claims, Enrollment, Provider Relations, Clinic, Scheduling, Transportation, Social Work and other internal departments to provide excellent service to our participants.
Research complex issues across multiple databases and work with support resources to resolve participant issues and/or partner with other departments to resolve escalated issues.
Provide PACE program navigation assistance to Participants (PTPs) during and after the 8-10 week orientation period.
Ensure that participants, families, and caregivers attain knowledge of PACE comprehensive health and psychosocial services, as well as PTP rights and responsibilities
Assist PTPs to understand service delivery processes that include but are not limited to timely access to primary and specialty care, language interpreter services, medication management, access to day health center services, 24-hour nurse on-call services, homecare, and coordination of ED, Hospital, and SNF services.
Assist in eliminating barriers to PACE services with advocacy and strategic navigation
Provide ongoing education, with motivational interviewing techniques to help PTPs remain compliant at participating in biannual interdisciplinary reassessments and at fulfilling care plan goals
Assist Social Workers to reduce and resolve PTP grievances, and prevent disenrollments.
Conducts frequent follow-up phone calls to participants, family members, and caregivers, with home visits as needed.
Provide escort assistance for offsite referral services as needed
Assist with communication and coordination of care between PTPs and IDT members, including PTP Primary Care Providers
Ability to pass PACE marketing exam within the first 60 days of employment.
Provide assistance with intake processes as needed
Able to demonstrate strong organizational skills.
Adaptive with demonstrated ability to perform and prioritize multiple work tasks.
Maintains a professional and positive attitude at all times.
Demonstrates compliance with Innovative Integrated Health policies and procedures and DHCS/CMS regulatory requirements
Attend and participate in staff meetings, in-services, projects, and committees as assigned.
Adhere to and support the center’s practices, procedures, and policies including assigned break times and attendance.
Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
Be flexible in schedule of hours worked.
May require use of personal vehicle