Care Navigator: Community & Field Outreach (Remote)

Moms Meals, Ltd; New York (NY); Remote; USD 34,000 - 36,000; Full time

Job summary

Mom’s Meals is seeking a Care Navigator to support Medicaid members and other eligible populations across New York in a hybrid role with local travel. Responsibilities include screenings, eligibility assessments, on-site navigation at events, and referral management to connect clients with social care services.

The role emphasizes trauma-informed, culturally responsive care, collaboration with partner organizations, and accurate documentation while traveling across New York State.

Qualifications

• Minimum of 2 years’ experience in healthcare, social services, behavioral health, community outreach, case management, care coordination, human services, or a related field.
• Experience engaging individuals from diverse communities and backgrounds with empathy, professionalism, and cultural humility.
• Ability to build rapport quickly in both community-based and telephonic settings.
• Experience conducting direct client interactions in-person, telephonically, or through community outreach activities.
• Strong verbal, written, and interpersonal communication skills.

Responsibilities

• Conduct standardized health-related social needs screenings in accordance with state and program requirements in community, partner organization, virtual, and telephonic settings
• Complete eligibility assessments and supporting documentation for social care services and enhanced navigation programs
• Provide in-person screening and navigation support at community events, health fairs, enrollment events, and outreach activities
• Build and maintain relationships with community-based organizations, healthcare providers, and local partners to increase awareness of available social care services
• Serve as an embedded Care Navigator within designated partner organizations, as assigned, providing on-site screening, referral coordination, and navigation services
• Initiate, monitor, and close referrals within designated referral management platforms
• Accurately document service activities, encounters, outcomes, and time spent in accordance with program billing and reporting requirement
• Perform closed-loop referral follow-up activities to confirm successful service connections and identify unresolved barriers
• Conduct outreach attempts and engagement activities in accordance with program timelines and documentation standards
• Educate individuals, caregivers, and community stakeholders regarding available benefits, community resources, and social care services
• Coordinate with healthcare providers, managed care organizations, community-based organizations, and other stakeholders to support continuity of care
• Represent the organization professionally in community settings and act as an ambassador for care navigation programs and services
• Escalate complex cases, urgent social needs, safety concerns, or barriers to supervisory or clinical staff as appropriate
• Maintain compliance with HIPAA, confidentiality requirements, and all applicable federal, state, and program regulations
• Meet productivity, quality, timeliness, documentation, and engagement standards established by the organization and program requirements
• Participate in ongoing training, workflow development, community engagement initiatives, and quality improvement activities
• Support reassessment, renewal, and recertification activities as required by program guidelines

Skills

Healthcare experience

Care coordination

Cultural humility

Community outreach

Empathy

Communication skills

Documentation

Microsoft Office

Travel willingness

Driver's license

Job description

Mom’s Meals is seeking a Care Navigator to support Medicaid members and other eligible populations across New York in a hybrid role with local travel. Responsibilities include screenings, eligibility assessments, on-site navigation at events, and referral management to connect clients with social care services.

The role emphasizes trauma-informed, culturally responsive care, collaboration with partner organizations, and accurate documentation while traveling across New York State.