Medicare Advantage Care Navigator

Paylocity; Orange (CA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Paylocity is seeking a Non-Clinical Case Manager to coordinate services for Medicare Advantage SNP members, assessing social, financial, and environmental needs and developing individualized care plans in collaboration with the ICT and caregivers.

The role focuses on connecting members with community resources, educating them on plan benefits, and supporting care transitions while escalating clinical concerns to licensed staff as needed.

Qualifications

• Bachelor’s or Master’s degree in Social Work (BSW or MSW), Human Services, Psychology, Public Health, or a related field.
• Social work licensure preferred (ACSW accepted; LCSW preferred).
• Relevant experience in case management, care coordination, managed care, healthcare, social services, or community-based programs may be considered in lieu of licensure.

Responsibilities

• Assess and plan care through psychosocial and needs assessments of members’ social, financial, and environmental needs.
• Administer initial Health Risk Assessments (HRAs) within CMS-required timeframes (within 90 days of enrollment) and annual reassessments for assigned C-SNP members.
• Develop, implement, and update individualized, goal-oriented care plans based on HRA results and member preferences, with ICT collaboration.
• Screen members for social determinants of health (SDOH) and health-related social needs.
• Coordinate access to community resources and provide warm handoffs and follow-ups.
• Educate members regarding plan benefits and support services.
• Assist members in navigating state and federal assistance programs.
• Connect members with chronic condition self-management education and related resources.
• Collaborate with ICT and other providers to ensure coordinated care.

Skills

Communication

Organizational skills

Problem-solving skills

Bilingual skills

Education

Bachelor’s or Master’s degree in Social Work

ACSW accepted

LCSW preferred

Job description

Paylocity is seeking a Non-Clinical Case Manager to coordinate services for Medicare Advantage SNP members, assessing social, financial, and environmental needs and developing individualized care plans in collaboration with the ICT and caregivers.

The role focuses on connecting members with community resources, educating them on plan benefits, and supporting care transitions while escalating clinical concerns to licensed staff as needed.