Dual-Eligible Care Navigator & Community Liaison

Partners in Care Foundation In; Fontana (CA); On-site; USD 70,000 - 90,000; Full time

Job summary

Partners in Care Foundation is seeking a Care Navigator to support Kaiser Permanente Medi-Cal and dual eligible members. This field-based role partners with Emergency Department teams to improve care coordination, engage members, and connect them to ECM, CCM, social services, and community resources.

Responsibilities include real-time ED engagement, enrollment support, warm handoffs to Medicare/Medi-Cal teams, post-visit follow-ups, and ongoing workflow refinement in a fast-paced hospital

Qualifications

• Experience working with Medi-Cal, Medicare, Dual Eligible populations, or CalAIM programs
• Familiarity with hospital or Emergency Department operations
• Strong communication and patient engagement skills
• Ability to navigate complex systems and coordinate across multidisciplinary teams
• Experience with care coordination, community resource navigation, or social service linkage preferred
• Comfortable working in fast paced operational environments and adapting to evolving pilot workflows

Responsibilities

• Review real time ED census lists and identify eligible members for outreach
• Conduct in person member engagement within the Emergency Department
• Prioritize outreach based on utilization patterns, clinical complexity, and operational workflow needs
• Participate in ED huddles, operational meetings, and staff workflows as an integrated member of the KP Sacramento ED team
• Support enrollment into Enhanced Care Management (ECM), including coordination with authorization teams when needed
• Provide navigation support for members already enrolled in ECM or other care coordination programs (Community Supports, Community Health Workers, etc.)
• Connect members to appropriate Kaiser Permanente services including: Transitional Care Services (TCS), Complex Case Management (CCM), Social Work, Medical Financial Assistance (MFA)
• Conduct basic assessments to identify and/or support social and community resource needs
• Connect members to community-based organizations and external support programs when appropriate
• Connect dually eligible members to the appropriate Kaiser Permanente Medicare or Health Care Options (Medi-Cal) resources for conversion, alignment, or benefits related support
• Coordinate warm handoffs to internal Medicare / Medi-Cal support teams when appropriate
• Assist non-KP Medi-Cal members with connection back to their assigned Managed Care Plan for available services and supports
• Conduct post visit telephonic follow up with members after ED discharge
• Participate in ongoing workflow refinement and pilot operational development
• Collaborate with ED leadership and KP operational teams to improve member identification and engagement processes
• Document outreach and interventions according to pilot workflows and operational guidance
• TB test
• Immunizations required- COVID-19, Hepatitis B, Influenza, MMR (Measles, Mumps, and Rubella), Pertussis and Varicella (chickenpox)
• Field-based role with regular travel for home visits, community coordination, and partner meetings.
• Must have reliable transportation and ability to meet member safely in community settings.
• Must provide proof of auto liability insurance with limits required by the state of California and valid California drivers license.
• Must be able to perform essential job functions such as lifting 5-10 pounds.

Job description

Partners in Care Foundation is seeking a Care Navigator to support Kaiser Permanente Medi-Cal and dual eligible members. This field-based role partners with Emergency Department teams to improve care coordination, engage members, and connect them to ECM, CCM, social services, and community resources.

Responsibilities include real-time ED engagement, enrollment support, warm handoffs to Medicare/Medi-Cal teams, post-visit follow-ups, and ongoing workflow refinement in a fast-paced hospital