SOCIAL CARE NAVIGATOR - Central Islip, NY

Economic Opportunity Council of Suffolk, Inc.; Village of Patchogue (NY); On-site; USD 45,000 - 65,000; Full time

Job summary

Economic Opportunity Council of Suffolk, Inc. in Patchogue, NY seeks a Care Coordinator to conduct Health-Related Social Needs (HRSN) screenings and provide care management for Medicaid Managed Care members. The role emphasizes coordinating community resources to improve social determinants of health.

The ideal candidate has 2+ years in care coordination, experience with Medicaid populations, and is bilingual in English and Spanish. Travel with a valid license and TB testing may be required.

Qualifications

• Demonstrated understanding of social determinants of health and experience addressing underserved populations.
• Proficient in using case management platforms; familiarity with Unite Us is a plus.
• Strong communication and interpersonal skills to build trust and rapport with clients.
• Ability to work independently with minimal supervision and adapt to evolving program guidelines.
• Capable of handling sensitive information with discretion and maintaining client confidentiality.
• Committed to trauma-informed, person-centered care practices.

Responsibilities

• Conduct standardized screenings for Health-Related Social Needs (HRSN) using the Unite Us screening tool.
• Provide care management services to Medicaid Managed Care members eligible for Enhanced HRSN Services.
• Coordinate access to community-based resources and services to address social determinants of health.
• Maintain accurate documentation and adhere to Medicaid and HEALI SCN program requirements.

Skills

Communication

Case management

Trauma-informed care

Education

High school diploma

Tools

Unite Us

Job description

Description

• Conduct standardized screenings for Health-Related Social Needs (HRSNs) using the Unite Us screening tool.
• Provide care management services to Medicaid Managed Care members eligible for Enhanced HRSN Services.
• Coordinate access to community-based resources and services to address social determinants of health.
• Maintain accurate documentation and adhere to Medicaid and HEALI SCN program requirements.

Major Responsibilities

• Conduct standardized screenings for Health-Related Social Needs (HRSNs) using the Unite Us screening tool.
• Provide care management services to Medicaid Managed Care members eligible for Enhanced HRSN Services.
• Coordinate access to community-based resources and services to address social determinants of health.
• Maintain accurate documentation and adhere to Medicaid and HEALI SCN program requirements.

Detailed Responsibilities

HRSN Screening

• Use the Unite Us IT platform to administer the HRSN screening tool via the phone
• Screen Medicaid members annually or after major life events (e.g., hospitalization, loss of benefits, change in housing).
• Obtain member consent, verify Medicaid eligibility, and confirm enrollment in Social Care Coverage.
• Ensure screenings are conducted in a private, secure setting and assess whether follow-up care or navigation is needed.
• Educate members on the purpose and outcome of screenings and assist in identifying next steps for support.

Enhanced HRSN Services Care Management

• Conduct Eligibility Assessments for Medicaid Managed Care members via the phone to determine qualification for Enhanced HRSN Services.
• Develop and manage individualized Social Care Plans, tracking referrals and outcomes in Unite Us.
• Coordinate services across multiple domains, including but not limited to transportation, utility assistance, home safety modifications, temporary housing, and cooking supply delivery.
• Collaborate with in house EOC program and external providers to ensure service delivery within designated timelines.
• Conduct follow-up with members to assess satisfaction, service impact, and need for additional referrals.
• Document all case notes, outreach attempts, and service updates according to HEALI SCN guidelines.

Qualifications

• Demonstrated understanding of social determinants of health and experience addressing the needs of underserved populations.
• Proficient in using case management platforms; familiarity with Unite Us is a plus.
• Strong communication and interpersonal skills to build trust and rapport with clients.
• Ability to work independently with minimal supervision, manage time effectively, and adapt to evolving program guidelines.
• Capable of handling sensitive information with discretion and maintaining client confidentiality.
• Committed to trauma-informed, person-centered care practices.

Education/Training/Experience

• High school diploma
• Minimum of 2 years of experience in care coordination, case management, social services, or a related setting.
• Prior experience working with Medicaid populations or community-based health programs preferred.
• Bilingual in English and Spanish
• Completion of HEALI SCN training(s) required upon hire

Requirements

• A Valid Driver's License and Insured Vehicle.
• PPD (TB test required with proof of results; no more than 1 year old)