Patient Navigator- Toledo Area - West Region
CareSource - Ohio

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Job Summary: The Patient Navigator provides one-on-one guidance, support, education, referrals, coordination of care, and other assistance to patients as they move through the healthcare continuum as directed by the CareSource RN Case Manager. Serving as a member of the CareSource Care Coordination Center’s Team*, the patient navigator is accountable for collaborating with other members of the CareSource Care Coordination Center’s Team and contributing to the implementation of the member’s care plan. This position is a collaborative team role and will be responsible for assessments, treatment plans and evaluation of high-risk members. Regularly review a member’s utilization rate, inpatient and emergency room history, HEDIS metrics and gaps in care.

Essential Functions:
1. Guide patients through the healthcare system by assisting with access to healthcare as directed by the CareSource RN Case Manager:

Accompanying patients to appointments and other social service encounters when necessary

Coordinating logistics for plan adherence – reminders, transportation, and childcare arrangements

Ensuring that medication adherence issues are addressed by ongoing reporting of issues to the CareSource RN Case Manager

Supporting patient family members

2. Participate in the implementation of comprehensive care plans:

Working with CareSource members in various community, care delivery and administrative settings

Developing relationships with community providers and resources

Managing resources through interdisciplinary collaboration to achieve optimal patient outcomes

Demonstrating effective communication skills with all stakeholders (e.g., members, team members, community providers and resources)

Maintain knowledge and understanding of business:
Providing timely and accurate documentation

Actively participating in team meetings

Developing and maintaining knowledge of the company’s business and regulatory environments

Travel:
Travel within the community and conduct face-to-face meetings with high-risk members, treatment plan personnel, providers and community leaders

Abide by the CareSource’s travel policy

Perform any other job related instructions as requested, with reasonable accommodation

Work Environment/Physical Requirements:
Mobile Worker: Will work at different office locations established by CareSource and will typically work in established geographical area in the community; may be required to stand and/or sit for long periods of time

Perform reasonable travel related duties including, member home visits, provider visits, and community based visits as needed to ensure administration of the program

Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer

Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members and may refer members to other CareSource’s resources

Position Requirements

Qualifications

Education:
High School Diploma or GED equivalent, is required

Certification/Licensure/Background Check:
Harold P. Freeman Patient Navigation Institute Certification, or equivalent approved training program, is required (or to be obtained within specific timeline)

Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated

Employment in this position is conditional pending successful clearance of a criminal background check. If the criminal background results are unacceptable, the offer will be withdrawn or, if you have started in this position, your employment in this position will be terminated

Experience:
Two years of experience in either volunteer or paid position working in community settings with at risk populations providing coordination of services, is preferred

Technical Skills:
Intermediate level of experience navigating in a Windows-based environment

Knowledge, Skills, and Abilities:
Sensitivity to and experience working within different cultures

Comfortable and interested in working with members around issues of healthcare access and adherence

Appropriate language proficiency

Ability to separate personal from professional and to set boundaries with members

Excellent understanding of local and community resources

Excellent interpersonal skills

Ability to work within a team environment

Ability to perform navigation with minimal supervision

Ability to identify problems and opportunities for Patient Navigation and report to CareSource Care Coordination Center’s Team

Ability to work in compassionate, supportive and collaborative ways with members and families

Self-motivated and Inquisitive

Comfort with asking pertinent questions

Ability to work in a fast-paced environment

Ability to demonstrate and promote ethical conduct

Ability to develop positive relationships with all stakeholders

Empathy and sensitivity towards each member

Ability to accept and appreciate feedback

Ability to provide input in assessing the needs of members and participate in the development of comprehensive care plans

Knowledge of healthcare resources, benefits and entitlements in the local area

Organized and detail-oriented

Initiative to plan and organize projects

Ability to keep composure and professionalism during times of high emotional stress

Ability to maintain confidentiality and act in the company’s best interest

Ability to act with diplomacy and sensitivity to cultural diversity

Conflict resolution skills

  • The Caresource Care Coordination Centers’ Team are made up of staff with a wide background of clinical and population specific experience to manage the unique needs of our complex membership, including experience in pediatrics, adults, behavioral health, NICU, prenatal, etc. The leadership team will continually review the experience and competency of staff to ensure they meet the needs of the population needs as they arise.
Educational Requirements

Education:
High School Diploma or GED equivalent, Required

License Requirements

Certification/Licensure/Background Check:
Harold P. Freeman Patient Navigation Institute Certification, or equivalent approved training program, is required (or to be obtained within specific timeline)

Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated

Employment in this position is conditional pending successful clearance of a criminal background check. If the criminal background results are unacceptable, the offer will be withdrawn or, if you have started in this position, your employment in this position will be terminated

Full-Time/Part-Time
Full-Time

Shift
Days

Salary
S06 $14.14/hr Min

About the Organization
CareSource is the 2nd largest Medicaid managed health care plan in the country, and our strength lies in our experience. CareSource provides a full spectrum of services for the administration of public-sector health care programs, serving more than 900,000 Medicaid consumers in Ohio and Michigan.
Our health plans are founded on the principles of quality and service delivered with compassion and a thorough understanding of Medicaid, Medicare, and the associated regulatory environments. We offer a unique approach to managed care through the process efficiencies and value-added benefits we offer to our members and the health care providers we partner with to serve them. As a managed health care organization, CareSource focuses on prevention with a goal of improving member health and the quality and accessibility of health care services for Medicaid consumers. CareSource assists in the coordination of member care by partnering with a defined network of participating doctors, hospitals and other health care providers.
CareSource Benefits
CareSource is an equal opportunity employer that offers a drug and tobacco free environment and a competitive compensation and benefits package to full-time and part-time employees who work at least 24 hours per week.

The benefits package includes:
  • Health, dental and vision insurance
  • Flexible spending accounts (health and dependent care)
  • Life insurance
  • Accidental death and dismemberment insurance
  • Short- and long-term disability insurance
  • 401(k) retirement plan
  • Liberal paid personal time to be used on a discretionary basis for sick leave or as scheduled time off
  • Eight paid holidays and a floating holiday
  • Educational reimbursement
For more information about CareSource, please see About Us on our website, www.caresource.com.

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