Care Navigator -In person-Riverside
Partners in Care Foundation In
3 days ago
Full-time
On-site
Riverside, California, United States
$21 - $25 USD hourly
Social Worker
Position Summary
The Care Navigator will be assisting Kaiser Permanente 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 ED leadership, care coordination teams, social work, Transitional Care Services (TCS), Complex Case Management (CCM), Medicare teams, and community partners to help members navigate Kaiser Permanente services, CalAIM programs, and community-based resources.
The role focuses on real time member engagement in the ED setting, with the goal of improving care coordination, reducing avoidable ED utilization, and connecting members to the appropriate ongoing supports after discharge.
Core Responsibilities
Member Identification and Engagement
Review real time ED census lists and identify eligible members for outreach
Conduct in person member engagement within the Emergency Department
Prioritize outreach based on utilization patterns, clinical complexity, and operational workflow needs
Participate in ED huddles, operational meetings, and staff workflows as an integrated member of the KP Sacramento ED 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 Kaiser Permanente 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 Kaiser Permanente 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 non-KP 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 ED discharge
Participate in ongoing workflow refinement and pilot operational development
Collaborate with ED leadership and KP operational teams to improve member identification and engagement processes
Document outreach and interventions according to pilot workflows and operational guidance
Preferred Skills and Experience
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
Other Requirements:
TB test
Immunizations required- COVID-19, Hepatitis B, Influenza, MMR (Measles, Mumps, and Rubella), Pertussis and Varicella (chickenpox)
Partners in Care Foundation is an equal opportunity employer. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. It is our intent to maintain a work environment which is free of harassment, discrimination, or retaliation because of age, race (including hair texture and protective hairstyles, such as braids, locks, and twists), color, national origin, ancestry, religion, sex, sexual orientation, pregnancy (including childbirth, lactation/breastfeeding, and related medical conditions), physical or mental disability, genetic information (including testing and characteristics, as well as those of family members), veteran status, uniformed service member status, gender, gender identity, gender expression, transgender status, arrest or conviction record, domestic violence victim status, credit history, unemployment status, caregiver status, sexual and reproductive health decisions, salary history or any other status protected by federal, state, or local laws. All qualified applicants will receive consideration for employment and reasonable accommodations may be made to enable qualified individuals to perform the essential functions of the position.
The Care Navigator will be assisting Kaiser Permanente 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 ED leadership, care coordination teams, social work, Transitional Care Services (TCS), Complex Case Management (CCM), Medicare teams, and community partners to help members navigate Kaiser Permanente services, CalAIM programs, and community-based resources.
The role focuses on real time member engagement in the ED setting, with the goal of improving care coordination, reducing avoidable ED utilization, and connecting members to the appropriate ongoing supports after discharge.
Core Responsibilities
Member Identification and Engagement
Review real time ED census lists and identify eligible members for outreach
Conduct in person member engagement within the Emergency Department
Prioritize outreach based on utilization patterns, clinical complexity, and operational workflow needs
Participate in ED huddles, operational meetings, and staff workflows as an integrated member of the KP Sacramento ED 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 Kaiser Permanente 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 Kaiser Permanente 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 non-KP 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 ED discharge
Participate in ongoing workflow refinement and pilot operational development
Collaborate with ED leadership and KP operational teams to improve member identification and engagement processes
Document outreach and interventions according to pilot workflows and operational guidance
Preferred Skills and Experience
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
Other Requirements:
TB test
Immunizations required- COVID-19, Hepatitis B, Influenza, MMR (Measles, Mumps, and Rubella), Pertussis and Varicella (chickenpox)
Partners in Care Foundation is an equal opportunity employer. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. It is our intent to maintain a work environment which is free of harassment, discrimination, or retaliation because of age, race (including hair texture and protective hairstyles, such as braids, locks, and twists), color, national origin, ancestry, religion, sex, sexual orientation, pregnancy (including childbirth, lactation/breastfeeding, and related medical conditions), physical or mental disability, genetic information (including testing and characteristics, as well as those of family members), veteran status, uniformed service member status, gender, gender identity, gender expression, transgender status, arrest or conviction record, domestic violence victim status, credit history, unemployment status, caregiver status, sexual and reproductive health decisions, salary history or any other status protected by federal, state, or local laws. All qualified applicants will receive consideration for employment and reasonable accommodations may be made to enable qualified individuals to perform the essential functions of the position.