Care Navigator / Contract / Onsite / Sacramento, CA
Exciting Care Navigator – Patient helper opportunity with an established firm. Contract Duration: 5 months and may extend beyond the end of the year. The Care Navigator will be embedded within the Sacramento Medical Center to support our client’s Medi-Cal members and dually eligible Medicare/Medi-Cal members. The role is designed to provide high touch navigation, engagement, and linkage support for members with complex medical, behavioral health, social, and utilization needs. The Care Navigator will work closely with the medical center’s leadership, care coordination teams, social work, Transitional Care Services (TCS), Complex Case Management (CCM), Medicare teams, and community partners to help members navigate our client’s services, CalAIM programs, and community-based resources. The role focuses on real time member engagement in the care setting, with the goal of improving care coordination; reducing avoidable ED utilization and readmissions; and connecting members to the appropriate ongoing supports after discharge. Required Skills & Experience Qualifications, Preferred Skills and Experience
- High school diploma with 2-5 years of relevant experience required; bachelor’s degree in social work, Psychology, Public Health, Human Services, Sociology, Gerontology, or a related field, preferred.
- Experience working with Medi-Cal, Medicare, Dual Eligible populations, or CalAIM programs
- Familiarity with hospital or Emergency Department operations
- Strong communication and patient engagement skills
- Ability to navigate complex systems and coordinate across multidisciplinary teams
- Experience with care coordination, community resource navigation, or social service linkage preferred
- Comfortable working in fast paced operational environments and adapting to evolving pilot workflows
- Bilingual and bicultural skills reflective of the communities served
What You Will Be Doing Member Identification and Engagement
- Review real time census lists and identify eligible members for outreach.
- Conduct in person member engagement within the care setting.
- Prioritize outreach based on utilization patterns, clinical complexity, and operational workflow needs.
- Participate in huddles, operational meetings, and staff workflows as an integrated member of the care team.
Care Navigation and Coordination
- Support enrollment into Enhanced Care Management (ECM), including coordination with authorization teams when needed
- Provide navigation support for members already enrolled in ECM or other care coordination programs (Community Supports, Community Health Workers, etc.)
- Connect members to appropriate services including:
- Transitional Care Services (TCS)
- Complex Case Management (CCM)
- Social Work
- Medical Financial Assistance (MFA)
- Conduct basic assessments to identify and/or support social and community resource needs
- Connect members to community-based organizations and external support programs when appropriate
Benefits
Support and Coordination
- Connect dually eligible members to the appropriate Medicare or Health Care Options (Medi-Cal) resources for conversion, alignment, or benefits related support
- Coordinate warm handoffs to internal Medicare / Medi-Cal support teams when appropriate
- Assist Medi-Cal members with connection back to their assigned Managed Care Plan for available services and supports
Member Follow-Up and Operational Integration
- Conduct post visit telephonic follow up with members after discharge
- Participate in ongoing workflow refinement and pilot operational development
- Collaborate with our client’s operational teams to improve member identification and engagement processes
- Document outreach and interventions according to pilot workflows and operational guidance
Posted By: Christopher Clinch