Health Care Navigator

Western New York Integrated Care Collaborative, Inc.; Town of Amherst (NY); On-site; USD 26,000 - 37,000; Full time

Job summary

Fallon Health Weinberg is seeking a FHW Care Navigator to advocate for Participants and caregivers, coordinate referrals and services, and ensure seamless communication with the care team in the Buffalo area.

The Navigator will engage in in-home visits, manage plan-of-care activities, and work with the interdisciplinary team to support optimal outcomes for dual-eligible residents.

Qualifications

• High school diploma required or equivalent.
• CPR certification or willingness to be certified within 60 days of hire.
• Access to reliable transportation to perform duties.
• At least 1 year of experience caring for frail or elderly populations.
• Home care or personal care experience preferred.
• Telephonic and in-person interviewing skills preferred.

Responsibilities

• Outreaches to all Fallon Health Weinberg Participants by phone or in person per state guidance.
• Ensure care plan provisional services are met and satisfied.
• Advocate for Participants.
• Respond to Participant/caregiver/Facility questions about authorized in-home services.
• Conduct in-home/institutional/office visits to orient Participants to the program and benefits.
• Coordinate with IDT members to review Participant status and needs.
• Ensure authorizations for services are entered into the EHR.
• Follow up after emergent or urgent care events or transitions.

Skills

Care advocacy

Care coordination

Interpersonal skills

Telephonic interviewing

In-person interviewing

Education

High School Diploma

Tools

EHR systems

Job description

Fallon Health offers a Program of All Inclusive Care for the Elderly (PACE) to serve the health needs of dual-eligible residents of the greater Buffalo area including Erie and Niagara counties.

FHW Care Navigator

The primary role of the Navigator is to advocate for the Participants and/or caregivers. The Navigator assists and works closely with the Home Care Coordinator Nurse acting as the community liaison ensuring satisfaction of the provisional authorized services developed via the plan of care. Responsibilities include managing referrals/authorizations and coordination of services of the plan of care.

Under the direction of the Clinical Nurse Manager, the Navigator assures timely completion of assigned work in conformance with established departmental policies and procedures. Able to demonstrate independent action. The Navigator presents a clear definition of problem(s) when reviewing with the inter-disciplinary team, clinical staff and other members of Fallon Health Weinberg.

Primary Job Responsibilities

• Outreaches to all Fallon Health Weinberg Participants via the telephone and/or in person as per state and organization recommendations
• Ensure care plan provisional services are being met and satisfied
• Acts as Participant advocate
• Responds to Participant/caregiver/Facility questions or concerns regarding authorized in-home services.
• Makes in home/institutional/office visits as need be to introduce self/role and ensure the Participant/caregiver/facility is orientated to the Program and benefits
• Coordinates and ensures members of the IDT (Clinical Nurse Manager, Home Care Coordinator, and others) are involved and knowledgeable about the Participant status based upon Enrollee always need and PCP/PCT direction
• Ensures authorizations for specific covered services are entered into the EHR as appropriate based upon authorized services
• Ensures the Home Care Coordinator follows up with Participant after an emergent/urgent care need and/or care transition such as a hospitalization or skilled nursing facility admission

$23.00 per hour

Qualifications

Education

• High School Diploma.

License/Certifications

• Access to reliable transportation.
• CPR certification, or willingness to be certified within 60 days of hire, is essential

Experience

• At least one year caring for the frail or elderly population.
• Home care or personal care experience preferred.
• Telephonic/ In-person interviewing skills preferred.
• Ability to transport self to/from meetings with Participants and/or vendor agencies in/around the program services area