Clinical - Care Navigator - J01009

Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans. The Care Navigator will manage an assigned caseload; conduct member outreach; assess barriers and resource needs; support care and service plans; coordinate referrals; complete in-person visits; collaborate with care managers and providers; and document activities timely and accurately.

Job Profile Summary

Position Purpose:
Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.

Education/Experience:
Requires a Bachelor s degree and 2 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure.

Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

License/Certification:
Current state s clinical license preferred
For Illinois YouthCare Plan only: Education/Experience: Bachelor's degree in Social Work, Nursing, Health Behavioral Science or equivalent experience. 2+ years of experience working within a social service agency and/or advocacy environment. Must reside in Illinois.
For Illinois YouthCare Plan Foster Care Liaison Roles only: Will be stationed on-site and hosted by DCFS Regional Offices throughout the State to provide administrative coordination with DCFS staff and stakeholders. Will be available during regular work hours to communicate with and to provide education and training to DCFS staff and stakeholders regarding managed care, and to engage in immediate problem resolution with Contractor's administrative staff. Will ensure that issues or barriers reported to a liaison must be addressed and the resolution communicated to appropriate DCFS staff or stakeholder.

For Health Net Federal Services only: Licensed Bachelor's or Master's Prepared Social Worker; LSW, LCSW, LICSW, or LMSW required

For Nevada SilverSummit (Medicaid) Healthplan: Licensed Bachelor's or Master's Prepared Social Worker: LSW or LMSW required.

For Mississippi Magnolia Health plan: Bachelor s or Master s degree in a healthcare related field (social work, sociology, psychology, public health) and 2 4 years of related experience; LSW,LMSW preferred.

For CMS Florida licensed practical nurse with a minimum of four years of pediatric experience, or a Master s degree in social work with a minimum of one year of related professional pediatric care experience. May require up to 80% local travel. required

Responsibilities:
Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome

Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care

Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans

Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner

May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate

Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators

May perform on-site visits to assess member s needs and collaborate with providers or resources, as appropriate

May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits

Other duties or responsibilities as assigned by people leader to meet the member and/or business needs
Performs other duties as assigned.

Complies with all policies and standards.

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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For CMS Florida licensed practical nurse with a minimum of four years of pediatric experience, or a Master s degree in social work with a minimum of one year of related professional pediatric care experience. May require up to 80% local travel. required Responsibilities: Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators May perform on-site visits to assess member s needs and collaborate with providers or resources, as appropriate May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits Other duties or responsibilities as assigned by people leader to meet the member and/or business needs Performs other duties as assigned. Complies with all policies and standards.
Story Behind the Need
The team supports Peach State members by identifying barriers to care, coordinating services, and connecting members with healthcare and community resources. A key focus is addressing social determinants of health (SDOH), including needs related to food, housing, transportation, utilities, education, and other non-medical factors that may affect a member s health and ability to access care. This new contingent role is needed to expand member outreach and field-based support, improve connections to community resources, and help close identified gaps. The Care Navigator will work in a collaborative, member-focused environment with care management and community resource partners. This request is for one position and is not part of a larger hiring initiative currently.
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?	The Care Navigator will manage an assigned caseload; conduct member outreach; assess barriers and resource needs; support care and service plans; coordinate referrals; complete in-person visits; collaborate with care managers and providers; and document activities timely and accurately. The role will also attend community events and partnership meetings, maintain relationships with existing community organizations, and identify and establish new community partners to expand available resources for members. Performance will be measured through caseload productivity, outreach and follow-up completion, documentation quality and timeliness, community engagement, partnership development, and compliance with applicable requirements. The role is unique because it combines remote coordination, direct field-based member support, and community partnership development across Georgia.
Candidate Requirements
Required: Education and experience requirements as listed in the Centene job description.			Preferred: Relevant degree or certification in social work, healthcare, human services, or a related field.
Required: Valid driver s license. No clinical license required.			Preferred: Relevant clinical or professional certification.
Years of experience required: 2 4 years of relevant care coordination, member outreach, community resource, social services, or healthcare experience. Disqualifiers: No valid driver s license; unwilling or unable to conduct in-person visits or travel locally; insufficient relevant experience; inability to work the required schedule. Additional qualities to look for: Strong communication, empathy, organization, sound judgment, follow-through, comfort working independently in the field, and ability to collaborate across teams.
Top 3 must-have hard skills stack-ranked by importance	1	Care coordination and assessment of member needs, barriers, and service options
	2	Community resource navigation, referral coordination, and member outreach
	3	Accurate, timely documentation and proficiency with standard computer systems
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations	Projected Manager Candidate Review Date:			1-2 days post shortlisting
	Type of Interviews:			Microsoft Teams interview with Nathaniel Rembert and one additional interviewer (TBD).
	Required Testing or Assessment (by Vendor):			None identified at this time.
Next Steps
Do you have any upcoming PTO?	Yes out of office October 19 23 and October 28.
Colleagues to cc/delegate	TBD