Job Description
Position Overview The Community Outreach Navigator under the direction of the Community Outreach Supervisor plays a critical role in providing support, guidance, and advocacy to individuals living with HIV. This role is primarily responsible for community-based engagement through home visits, health facility outreach, and collaboration with healthcare providers and community partners to re-engage patients in care and improve health outcomes. With appropriate training/certification, they serve as a facilitated enroller to support HIV SNP enrollment and Medicaid recertification as appropriate. Scope Of Role & Responsibilities Community Outreach/Care Coordination Conduct independent, unaccompanied, home, hospital, or community field visits to locate members who are lost to care or at risk of disengaging from care, spending up to four to five days per week in the field. Engage patients in their homes, community locations, or healthcare facilities to assess barriers to care and support re-engagement with primary care services including accompaniment to medical or non-medical appointments. Provide health coaching and motivational support to empower members in staying connected to HIV primary care and treatment. Collaborate with healthcare providers, care managers, and community organizations to coordinate services that address member needs. Schedule medical appointments, arrange transportation, and facilitate medication access to remove barriers to care. Support HIV-positive Medicaid and HARP members to recertify their Medicaid, to engage in care with an HIV specialist provider, and to enroll into the HIV special needs plan as a facilitated enroller or through referral pathways, as appropriate. Track all medical, behavioral, and other referrals ensuring members attend appointments, through reminder calls and accompaniment when necessary. Monitor utilization including ER visits, hospitalization admission/discharge information, and behavioral health services to find opportunities for engagement with members. Document outreach efforts, patient interactions, and care coordination activities in the appropriate case management systems. Build trusting relationships with patients from diverse backgrounds using culturally sensitive and strengths-based approaches. Participate in case conferences, training sessions, and quality improvement initiatives. Educational/Enrollment Process Educate and provide assistance to qualified individuals with applying for coverage through the NY State of Health Marketplace for Medicaid programs. Assist consumers/applicants by calling the NY State of Health Customer Services Department for assistance with enrolling and/or providing verification documentation. Explain how potential eligibility for Medicaid programs works and would impact the consumer. Describe the features and benefits of health insurance coverage. Assist consumers with submitting documents and information as required by the Marketplace via scan, fax or mail. Assist existing members with recertification, when applicable. Regulatory/Compliance Securing and safeguarding confidential information to prevent Protected Health Information (PHI) from being obtained from unauthorized personnel to ensure compliance with privacy and security standards. Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Marketplace. Participate in all training, updates and webinars and other forums in which information is necessary to carry out roles and responsibilities. Mandated to meet the annual MFE recertification requirements. Keep abreast of all industry and regulatory updates as it pertains to the Marketplace. Maintain discretion regarding business-related files, reports and conversations within the provisions of applicable State and Federal Statutes and regulations. Tactical Maintain a daily tracking tool that entails detailed activity. Monitor all applications in personal dashboard to ensure timely and accurate follow-through from applicants. Conduct a daily review of personal dashboard to address and follow-up on any and/or all potential leads for consumers seeking assistance. Maintain a consistent supply of various educational and product line collateral. Keep abreast of all the Marketplace functionalities to effectively manage individual accounts. Data enter all applicant demographic, enrollment site and PCP selection data in the required "Enrollment Program" within the MetroPlusHealth portal at the time of the initial enrollment encounter. All other tasks and responsibilities as may be re