Physician Health Partners Looking for Care Navigator (Medicaid) at Colorado Springs, CO Full Time

Position Summary: The Care Navigator will be responsible for the following: a) contractual outreach requirements, outreach to special populations such as high cost members and populations defined through CCHA’s KPI initiatives; b) extended care coordination activities for member’s with primarily non-clinical needs; c) conducting telephonic and in-person or field-based care coordination and system navigation for members with physical and behavioral health needs; d) liaising between members and their primary care and/or behavioral health providers for streamlined care coordination, appointment scheduling, follow up, and member advocacy; e) coordinating between local service organizations, agencies and/or medical facilities in which the Care Navigator might be based; f) initiating and completing care plans for physical and behavioral health, member identified goals and communicating care plan progress to primary care providers and behavioral health providers; g) conducting in-person screenings at facilities in which the Care Navigator might be embedded; and h) supporting clinical care coordination programs through embedded and/or integrated program activities.

COMPETENCIES/Role-Specific Functions:

COMMUNICATION

Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.

• Provides feedback and recommendations to leadership regarding Care Navigator duties and functions
• Promotes communication among team to identify and streamline roles and responsibilities
• Participates in meetings and presents information as needed
• Effectively communicates both verbally and written with clients, members, and care coordination team
• Reliably consumes instructions from leadership and asks clarifying questions
• Reports on outcomes related Care Navigator initiatives
• Communicates professionally with providers, physicians, and other healthcare professionals

PROBLEM SOLVING

Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues, understands the difference between critical details and unimportant facts.

• Accurately coordinates referrals to other team members by: a) assessing for level of urgency and level of risk; b) reviewing, documenting, and determining appropriate level of care; and c) creating appropriate case requests
• Implements appropriate intervention(s) in a timely manner to assure problem prevention and resolution
• Identifies, develops, and utilizes community resources appropriately
• Uses motivational interviewing to achieve desired outcomes for the member
• Effectively navigates systems in order to obtain information needed for specialized projects

PRODUCTIVITY

Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, handles information flow.

• Meets case workload and documentation requirements as defined by department standards
• Contributes to the Care Coordination team through staff meeting attendance and participation, lending assistance to co-workers and other PHP similar activities
• Tracks and reports results of outreach projects and co-location activities
• Monthly and ad-hoc reporting duties as assigned
• Single Point of Contact for co-location and/or clinical care coordination program

SELF DEVELOPMENT

Seeks out and accepts feedback, is a proactive learner, takes on tough assignments to improve skills, keeps knowledge and skills up-to-date, turns mistakes into learning opportunities.

• Has ability to receive feedback and apply it to work performance
• Identifies opportunities for, and participates in, continuing education including workshops, conferences, specific publications, etc.

CUSTOMER FOCUS

Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.

• Has working knowledge of local community programs, government and social agencies, and conveys that knowledge to team members when appropriate
• Develops strong relationships with members to include handling escalated members and/or members with high acuity and high intensity needs
• Advocates on behalf of members with providers, specialists and community agencies
• Follows up with high acuity and high intensity members to ensure their needs are met

JOB KNOWLEDGE

Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues.

• Acts as the subject matter expert for Care Navigator initiatives to assure best practices in outreach, engagement and communication
• Understands and effectively utilizes “specialized” resources
• Understands integrated care coordination program requirements
• Maintains confidentiality and ensures compliance with HIPAA regulations
• Other duties as assigned

Qualifications (Education/Experience/Knowledge/Skills/Abilities):

• High school diploma or GED required.
• Bachelor’s degree, and/or experience in a Social work, or Behavioral Health realted field, Licensed Practical Nurse, or certified Medical Assistant preferred.
• Minimum one to two years in a healthcare setting.
• Minimum one to two years of customer service phone experience preferred.
• Advanced computer skills utilizing Microsoft Excel, Word and Outlook.
• Possess excellent customer service skills and ability to effectively interact with PHP personnel, medical and facility staff, other healthcare professionals and the general public.
• Precise and detail oriented in managing, editing and communicating information through spreadsheets and computer systems.
• Ability to work effectively and communicate with other teams and personnel within the PHP organization.
• Skilled in conflict management, problem prevention and resolution.
• Knowledge of medical terminology.
• Able to accept and work with diverse populations and provide culturally sensitive education and assistance to patients/families.
• Available to begin workday as early as 8 am.
• A valid unrestricted Colorado drivers’ license.
• Reliable and insured vehicle.
• Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures.
• Mobile Device for work purposes as defined by the company policies and procedures.

COVID-19: Employees will be required to show proof of being fully vaccinated to COVID-19 within 30 days of hire. Reasonable accommodations may be considered on a case-by-case basis for certain exemptions in accordance with applicable law. Applicants should be aware, though, that for external-facing roles, particularly those involving close contact with vulnerable individuals, accommodations that involve not being vaccinated against COVID-19 may not be deemed reasonable. The Company will engage in the interactive process on an individualized basis in light of each particular role.