Enhanced Care Management Care Navigator

POSITION TITLE:  Enhanced Care Management Care Navigator

DEPARTMENT:  Behavioral Health

REPORTS TO:  Enhanced Care Management Program Manager

SUPERVISION GIVEN: none

LOCATION: West Fairfield, CA

 

$28.00 To 32.16 Hourly

 

 

ABOUT OLE HEALTH

Since 1972, OLE Health has provided comprehensive care to all individuals regardless of insurance or ability to pay. OLE’s Health offers primary care, dental, optometry, and behavioral health services and embraces a patient-centered model of care. By emphasizing care coordination across departments, as well as referral and enrollment services, we ensure all the patients’ health and well-being needs are met. OLE Health has six health centers across Napa and Solano County and serves 40,000 patients annually.

 

In 2022, OLE Health was named as one of the top 100 places to work by the North Bay Business Journal, recognized for quality by the federal Health Resources and Services Administration, and awarded for Nonprofit Excellence by the Center for Volunteer and Nonprofit Leadership. If you’re looking to join a passionate team focused on serving its community, then consider applying for a position with OLE Health.

JOB SUMMARY:

Enhanced Care Management (ECM) is a whole-person, interdisciplinary approach to care that addresses the clinical and nonclinical needs of Members with the most complex medical and social needs through systematic coordination of services and comprehensive care management that is community based, interdisciplinary, high touch and person centered. Under the direction of the ECM manager and in conjunction with the ECM team, The Care Navigator will:

 

  • Assist the ECM Member in navigating health care (medical, dental, behavioral health) and social service resource systems
  • Provide ongoing care that is patient centered, outcome oriented, linguistically, and culturally appropriate
  • Work to develop, implement, document, and maintain a care plan in conjunction with each ECM Member
  • Assess and address social determinants of health
  • Meet with the ECM Member in their homes, at a neutral location in the field or at OLE Health sites
  • Monitor and maintain Member enrollment status, release of information, care plans and ED/in-patient/long-term facility stays and readmission patterns for ECM Members

KNOWLEDGE OF WORK

Knowledge of Organizational Improvement Methods
Knowledge care navigation best practices
Knowledge of Federally Qualified Health Centers and the key health center principles and guidelines

 

DUTIES AND RESPONSIBILITIES

Provides community-based, high-touch, on-the-ground, face-to-face interactions with ECM Members.     Assists clients in their homes, community, or clinic setting
Maintains a caseload of approximately 30 ECM Members
Collaborates with ECM team and OLE Health staff including nursing, medical, dental, behavioral health, and care coordination to ensure the full spectrum of ECM services and benefits are implemented
Accompanies ECM Members to medical and other service-related appointments when necessary
Identifies and addresses social determinants of health
Develops a care plan and works with the ECM Member to formulate and execute realistic, time specific and measurable goals
Motivates ECM Members to be active and engaged participants in their health and overall wellbeing.
Assists ECM Members in utilizing community services, including scheduling appointments with social services agencies, and assisting with completion of applications for programs for which they may be eligible.
Acts to reduce cultural and socio-economic barriers between ECM Members and institutions.
Develops relationships with local community organizations to implement interventions that address social determinants of health
Monitors the Collective Medical software for ED/in-patient/long-term facility stays and readmission patterns
Maintains updated ECM Member status and uploads Releases of Information, and Care Plans onto Collective Medical
Abides by OLE Health protocols regarding outreach staff and Member health and safety
Sustains accurate, detailed, and timely documentation of client interactions on the EHR.
Works closely with the Quality Improvement team to ensure patient interaction and data collection meet QI incentives/certifications.
Performs other duties as assigned

 

BENEFITS:

 10 Paid Holidays

 Vacation &S ick (16 days)

 Medical, Dental, Vision

 403(b) retirement plan with a 4% match

 Tuition Reimbursement

 Life insurance

 Flexible Spending Account

Apply Here