Social Care Navigator - Hybrid

MAJOR RESPONSIBILITIES :

• Conduct standardized screenings for Health-Related Social Needs (HRSNs) using the Unite Us screening tool.
• Provide care management services to Medicaid Managed Care members eligible for Enhanced HRSN Services.
• Coordinate access to community-based resources and services to address social determinants of health.
• Maintain accurate documentation and adhere to Medicaid and HEALI SCN program requirements.

DETAILED RESPONSIBILITES :

HRSN Screening :

Use the Unite Us IT platform to administer the HRSN screening tool via the phone

Screen Medicaid members annually or after major life events (e.g., hospitalization, loss of benefits, change in housing).

Obtain member consent, verify Medicaid eligibility, and confirm enrollment in Social Care Coverage.

Ensure screenings are conducted in a private, secure setting and assess whether follow-up care or navigation is needed.

Educate members on the purpose and outcome of screenings and assist in identifying next steps for support.

Enhanced HRSN Services Care Management :

Conduct Eligibility Assessments for Medicaid Managed Care members via the phone to determine qualification for Enhanced HRSN Services.

Develop and manage individualized Social Care Plans, tracking referrals and outcomes in Unite Us.

Coordinate services across multiple domains, including but not limited to transportation, utility assistance, home safety modifications, temporary housing, and cooking supply delivery.

Collaborate with in house EOC program and external providers to ensure service delivery within designated timelines.

Conduct follow-up with members to assess satisfaction, service impact, and need for additional referrals.

Document all case notes, outreach attempts, and service updates according to HEALI SCN guidelines.

QUALIFICATIONS :

Demonstrated understanding of social determinants of health and experience addressing the needs of underserved populations.

Proficient in using case management platforms; familiarity with Unite Us is a plus.

Strong communication and interpersonal skills to build trust and rapport with clients.

Ability to work independently with minimal supervision, manage time effectively, and adapt to evolving program guidelines.

Capable of handling sensitive information with discretion and maintaining client confidentiality.

Committed to trauma-informed, person-centered care practices.

Required Valid New York Driver's License and Insured Vehicle

PPD Required before start date

EDUCATION / TRAINING / EXPERIENCE :

High school diploma

Minimum of 2 years of experience in care coordination, case management, social services, or a related setting.

Prior experience working with Medicaid populations or community-based health programs preferred.

Bilingual in English and Spanish

Completion of HEALI SCN training(s) required upon hire

CATEGORY :

NON-EXEMPT