NAVIGATOR

General Description Of Position

Will facilitate consumer enrollment in a Qualified Health Plan (QHP) through the Federal Marketplace and or other health programs such as Medicaid and CHIP by providing fair, impartial, and accurate information that assists consumers with submitting the eligibility applications, clarifying distinctions among QHP's, and providing information to qualified individual. The Navigator will conduct consumer assistance activities to both consumers and businesses. Provide health literacy the basic understanding of the rights and concepts related to health coverage and how to use it. Promotes application assistance for Affordable Care Act, Marketplace Insurance, CHIP, Medicaid. Provide referrals and patient registration follow-up to Outreach team. Works with the CMS Navigator Project Manager to reach goals and objectives of program. Participates in coalition meetings, community events and presentations to promote Marketplace Insurance enrollment and assistance. Educates families on the importance of renewals and insuring children with CHIP or Children's Medicaid. Position requires successful certification of the CMS FFE examination.

This position is a five-year grant and hiring date is anticipated to be September 3, 2024 upon notification of award.

ESSENTIAL JOB FUNCTIONS: (with or without accommodations)

Patient Relationship: Will greet and welcome the patients/clients in a pleasant, respectful, culturally and linguistically appropriate manner. Assure all patient/client questions are answered in a cordial manner. Assures the patient/client has a clear understanding when providing Marketplace insurance information, application assistance or information on qualified health plans. Educates and provides enrollment opportunities to the families of Cameron & Willacy Counties on Marketplace eligibility under the Affordable Care Act. Conducts community bi-lingual presentations (English/Spanish) and other activities to promote program. Works with families individually or in groups to increase access to health and social services. Provides information on ACA Enrollment applications, assists in completing and submitting application according to guidelines. Guides families to ensure application and renewal process is completed in a timely manner. Provides CHIP/Medicaid application and renewal assistance to patients of Su Clinica and the community. Provide services to patients and community members by in-person assistance, assistance over the phone, virtual or video assistance, and other remote assistance like email or text.

Manages patient/client information: Adheres to all HIPAA regulations in and outside of the Clinic. Follows all Su Clinica policy and procedures to assure compliance and safety. Assures all documentation for Application Assistance follows CMS rules and regulations for Navigators.

Community Supports: Coordinates and/or participates in community health fairs/presentations. promotes application assistance, enrollments distribution of promotional items. Develops collaborative community relationships with local institutions to promote Marketplace enrollment and health literacy. Conducts lobby presentations within Su Clinica to promote application assistance and enrollment. Identifies patients who could benefit from other services such as Women’s Health, Pediatrics or Pedi Dental and refer to outreach for assistance. Will focus on Medicaid/CHIP application assistance during non-enrollment periods. Conduct enrollment drives and works with community partners to increase the number of clients needing application assistance and enrollment.

Demonstrates Navigator Skills and Abilities: Completes and maintains annual certification/re-certification for Navigator status. Navigator certification is a requirement of employment with Su Clinica. Must be bi-lingual and culturally competent to serve the communities of Cameron and Willacy counties. Under the supervision of the CMS Navigator Project Manager will submit reports with performance matrix required that are accurate and timely. Reports will be based on grant requirements. Post-enrollment assistance will require resolving enrollment issues and providing referrals to appropriate sources. Tax forms and appeals will include aiding with Marketplace forms, exemptions and appeals.

Team Communication

Actively participates in team huddles and staff meetings to assure focus is on goals and objectives. Meets with the Project Manager to ensure that the productivity and schedule is reviewed and that all activities are covered. Works with clinic personnel to ensure a smooth and successful coordination for applicants requesting information about Su Clinica. Communicates special event information to other departments within the clinic that may be affected and/or need to know. Provides timely and accurate reports as required.

Demonstrates Safe Professional Conduct

Maintains a friendly and safe environment for self and others. Refrains from texting and speaking on personal cell phone while on duty. Will maintain the phone on mute to avoid hearing the ringing of personal cell phone. Fully participates in performance improvement and follows all clinic policies and procedures. Responsible for own safety and the safety of others. Attends work on a regular predictable schedule in accordance with clinic leave policy notifying Project Manager of all absences. Submits required documentation in a timely manner (credentialing requirements, license renewals, certifications, continuing education attendance, etc.) Will fully always comply with the enhanced infection control requirements of the clinic. Approaches patient care as a team involving clinical and non-clinical staff to achieve patient care objectives.

POSITION DIRECTLY SUPERVISED: None

KNOWLEDGE, SKILLS, AND ABILITIES: (use of equipment, job-related knowledge, language, etc.)

Ability to fully comply with the enhanced infection control requirements of the clinic

Knowledge and skilled in use of computer and computer software (EMR, Microsoft Word, Excel, etc.) programs as necessary

Knowledge of community resources

Knowledge of SC policies and procedures.

Knowledge of the Chronic Care Model and Patient-Centered Medical Home Model (PCMH).

Knowledge of community demographics

Knowledge of outreach techniques

Skilled in the preparation in the conducting of group presentations

Skilled in coordinating activities

Skilled in excellent customer service

Ability to complete required Compliatric courses in timely manner.

Ability to schedule patients for needed appointments.

Ability to prepare records/reports in accordance to detailed instructions and complete projects independently

Ability to work with minimal supervision

Ability to effectively manage time and handle multiple priorities

Ability to attend workshops and conferences in and out of town

Ability to examine documents for accuracy and completeness.

Ability to maintain a flexible work schedule following clinic leave policy

Ability to maintain an effective and professional working relationship with the public and co-workers.

Ability to maintain client, office confidentiality and abides by confidentiality expectations and HIPAA guidelines.

Ability to prepare records in accordance with detailed instructions.

Ability to read, write and speak in a clear, accurate and professional manner; includes active listening skills and understanding medical terminology.

Ability to work in a fast-paced environment.

Able to bend, stretch, stoop, stand, sit, and lift 30 lbs.

Able to show excellent interpersonal skills reflecting clarity, diplomacy and communicate accurately and effectively with all levels of staff and management.

Ability to communicate concerns to appropriate personnel using tact and diplomacy.

MINIMUM QUALIFICATIONS/CERTIFICATES/LICENSES/REGISTRATIONS REQUIRED: High School Diploma or GED with five years’ experience completing ACA Marketplace, CHIP, Medicaid, TANF, private insurance companies or insurance billing applications or an associate degree with two years’ experience as described above. Bi-lingual English/Spanish required. Certified or be able to successfully become certified as a CMS FFE navigator.

SPECIAL INSTRUCTIONS: This position requires travel. Employees must provide transportation. If employee operates a personal motor vehicle the employee must possess a current valid Texas driver’s license for the appropriate type of vehicle and Texas Liability insurance. This position requires that an employee’s driving record be verified with law enforcement to ensure compliance with SC’s driving policy. Due to the nature of the position employee will work extended hours or other variations of the usual shift to ensure adequate care for patients and to maintain service to the community to include weekends. This is a grant funded position for 5 years.