*Important note: This specific posting is for Sacramento County and requires at least 2-3x a week in person work with clients in community based settings. Please only apply for this position if you are able to meet the hybrid requirements of this position. *
Agency: A Senior Connection
Job Title: Patient Care Navigator or Lead Care Manager
Reports to: Lead Care Manager and/or Program Supervisor
Work in collaboration with: Care Coordinators, Community health Workers, Program Director, medical/health care providers (primary care physicians, nursing staff, mental health workers). These positions will be within our Transitional Care Program (TCP) and CalAIM programs.
Location: This is hybrid position. You will be required to have a HIPAA complaint at home office and meet (at minimum quarterly) in Sacramento and surrounding counties. While the position is hybrid, you must be located in Northern California. Those who do not reside in the surrounding areas will not be considered.
Position Summary
The Patient Care Navigator/Lead Care Manager (LCM) provides Telephonic and field-based care navigation services to clients enrolled in the CalAIM Enhanced Care Management (ECM) and Community Support Program (CS) and/or Transitional Care Program (TCP).
The Patient Care Navigator builds strong relationships with clients to help clients stay engaged in medical care and adhere to their medications. Patient Care Navigators are committed to removing the client’s barriers to care by identifying critical resources for clients, helping them navigate through health care services and systems, and promoting client health. They work closely with the CalAIM and TCP team members and collaborating organizations and providers within their service area.
Responsibilities
- Telephonic and field-based outreach to engage clients in our care management program
- Establishes close relationships with partners and serves as a point of contact for patients
- Provides health education to patients to promote self-management
- Communicates with Care Team members on a routine basis to support care delivery for patients
- Identify and connect patients to resources for clients to overcome barriers to care, such as transportation, housing, food, and other social service resources
- Maintain strict confidentiality in accordance with agency policies
- Schedule and attend primary care physician appointments to review and update care plan with the care team
- Assist with outreach telephone calls to reduce care gaps and keep patients engaged in care
- Provide comprehensive health navigation including assistance with:
- Health insurance enrollment and verification
- Appointment scheduling for providers and specialist
- Appointment scheduling, confirmation, and reminders
- Interpretation and completion of forms and paperwork
- Directing patients to community organizations based on their needs
- Working with clinical teams to review and ensure understanding of treatment plans
Organizational duties:
- Meet with care team to discuss patient care issues and needs and developed shared care plans
- Maintain documentation of all patient encounters and complete reporting requirements according to organization standards
- Track client information, schedules, files, and forms in a confidential manner
- Track client attendance at medical appointments and patient navigation sessions and initiate outreach and missed appointment procedures, as necessary
- Attend all scheduled staff meetings
- Work collaboratively with all members of the care team and extended medical team
- Active participation in team huddles
- Active participation in multidisciplinary committees and workgroups
- Assist with the training of new staff in collaboration with leadership and preceptors/mentors
- All other duties as assigned
Qualifications
Personal characteristics and skills:
- Commitment to the mission of care coordination
- Passionate, trustworthy, and empathetic when working with clients
- The ability to problem solve independently as well as the ability to collaborate in a team setting to work toward a specific goal
- Ability to build relationships with different types of people, including patients, organizations, members, and health care providers
- Good communication and interpersonal skills and ability to speak concisely to clients and Care Team members
- Organized with confidential client material and appointment tracking
- Flexible and adaptable in response to changing client and health care providers’ needs
- Interest in working with underserved and marginalized populations
Education and experience:
- Minimum high school degree or equivalent, AA preferred
- At least 2 years of care coordination or case management experience
- At least 1 year experience working with diverse and marginalized populations
- Strong understanding of cultural competency with the target population
- Written and oral fluency in English and Spanish is preferred
- CalAIM experience preferred (ECM *and* CS)
- Knowledge of different MCP in Sacramento/SJST/Placer Counties preferred
- Experience working in community-based settings for at least 1-2 years preferred
- Submitting authorization requests, referrals, applications
- Familia with SNF, BC, RB, AL, Memory Care
*Please answer the pre-screen questions to be considered for this role.
Job Type: Full-time
Pay: $25.00 - $30.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Health insurance
- Paid time off
Application Question(s):
- Briefly describe your case management experience, including the populations you’ve served and the types of services you coordinated.
- Which Managed Care Plans (MCPs) have you worked with directly, and what types of authorizations, care coordination, or services did you manage for them?
- Describe your experience working with CalAIM or other California care coordination programs. What was your role, and how did you apply CalAIM guidelines in your case management workflow?
- Required Acknowledgment – Please Read Carefully
To be considered for this position, please type "YES" below to acknowledge the following:
-I understand that case management experience is required for this position.
-I understand that CalAIM knowledge is highly preferred.
-I understand that completion of all prescreen questions is required to be considered for employment.
-I understand that applications with incomplete prescreen responses may not be considered.
Education:
- High school or equivalent (Required)
Experience:
- Case management: 2 years (Required)
Work Location: Hybrid remote in Sacramento County, CA
