HRSN Navigation Coordinator

Responsible for the oversight and delivery of screening individuals enrolled in a Medicaid Managed Care (MMC) Plan or screening Medicaid Fee-For-Service (FFS) Members for Health-Related Social Needs (HRSN) using the Accountable Health Communities Health Related Social Needs Screening Tool.  Assesses Member’s eligibility for Enhanced HRSN Services and refers eligible members to an appropriate Enhanced HRSN Service.  For those who do not meet the eligibility criteria for Enhanced HRSN Services/Fee-For-Service Members eligible for Navigation services, the HRSN Navigation Coordinator will determine the type of assistance needed for the Member to be connected to existing federal, state, and local programs, as relevant. Responsible for the oversight of the services provided by the HRSN Certified Dietician, which includes nutrition counseling and education to eligible recipients.

POSITION RESPONSIBILITIES

• Provides direct supervision and oversight to the HRSN Screener/Navigator.
• Provides direct supervision and oversight to the HRSN Certified Dietician.
• Utilizes the Social Care Network (SCN) IT Platform to find Member information and screening Tool, conduct Screenings, and enter screening services for payment.
• Checks each Member’s screening history to minimize duplication of screenings that are unwanted or not reimbursable.
• Obtains consent to share member’s information prior to conducting any screening.
• Within seven days of receiving referral, screens Members for HRSNs using the Accountable Health Communities Health Related Social Needs (AHC HRSN) Screening Tool, which will collect Member Consent (using script provided in platform), Member demographic and contact information, and data related to the Member’s HRSNs.
• Sends Screening data to the SCN IT Platform and the SCN Lead Entity within 24 business hours of screen.
• Documents major life events which triggers a re-screening within the Member’s Social Care Plan.
• Utilizes the SCN IT Platform to conduct social care navigation activities, including Eligibility Assessments, Social Care Plan development, sending and tracking referrals, and entering Navigation services for payment.
• Uses Enhanced Services Member File data to assess the Member’s eligibility for Enhanced HRSN Services following the screening and confirmation of unmet HRSNs, ensuring consent is obtained.
• Informs Members or their right to make a complaint or grievance.
• Informs Members of any additional services the organization provides through the waiver.
• Navigates Members who opt out of receiving or do not meet the eligibility criteria for Enhanced HRSN Services, or are eligible FFS Members, to existing federal, state and local programs.
• Refers Members to appropriate Enhanced HRSN Service(s) to meet unmet needs, providing for at least 3 choices for every service need identified. Documents that 3 choices were provided.
• Communicates the response of referral from Service Delivery Partner with the Member.
• Develops a Social Care Plan for each MMC Member who is eligible for Enhanced HRSN Services.
• Checks in regularly with the Member to ensure satisfaction of services.
• Contacts Members receiving Enhanced HRSN Services at the end of service delivery to ensure service completion, identify persistent needs, and support in transitioning Members to additional supports where relevant and desired.
• Checks Member’s Medicaid eligibility on a bi-weekly basis to verify the member is still a MMC member.
• If a Medicaid lapse occurs, conducts an expedited review and assists members with re-enrollment planning as well as notifies the member and HRSN service provider of the lapse.
• Collaborates with the SCN Lead Entity on data-driven performance reporting in response to any regulatory reporting obligations.
• Reports all Member incidents, compliance concerns, grievances or complaints using the Integrated Cared Incident Report.
• Reports any suspected child abuse or neglect.
• Completes all required documentation and billing requirements for service delivery.