Become a part of our caring community and help us put health first

　　The Role

　　Working within an interdisciplinary care team, the Care Navigator is responsible for proactively engaging patients identified as high-risk and implementing targeted interventions to address social needs and increase access to care. The Care Navigator will provide guidance and oversight of care coordination efforts to other members of the team, and handle clinical escalations as indicated.

　　This role requires an understanding of how socio-economic stressors can impact ability to engage in healthcare and subsequent health outcomes. Experience will ideally include prior work with patients with behavioral health diagnoses, as well as in navigating local community-based resources and benefit applications.

　　This role has a mobile presence, involving travel to patients' homes, treatment facilities and community-based settings, and assigned clinics to facilitate and foster connections.

　　Major Duties and Responsibilities

　　Conduct Transitions of Care Management for a subset of the patient population, including ER and hospital follow ups

　　Provide triage guidance and supportive consultation to other team members, handling escalated complex cases

　　Develop care plans leveraging 5Ms Geriatric best practice framework

　　Develop a wholistic view of patient needs related to Social Determinants of Health

　　Identify existing barriers to engagement with necessary resources and supports

　　Provide education around maintenance of chronic health conditions, as well as available options for behavioral care and social support

　　Serve as liaison between the patient and the direct care providers, assisting in navigating both internal and external systems

　　Initiate care planning and subsequent action steps for high-risk members, coordinating with interdisciplinary team

　　Supporting patients' self-determination, motivate patients to meet the health goals they have identified

　　Refer patient to necessary services and supports

　　This field may include but is not limited to: assistance with transportation, food insecurity, navigation of and application for benefits including, Medicaid, HCBS, working to reduce costs associated with prescription medications, organizing schedules of follow up appointments, alleviating social isolation

　　Lead Interdisciplinary Team Meetings when indicated

　　Assess patient's family system, and conduct family meetings with patient and family when needed

　　Participate in creation and facilitation of team training content

　　Conduct group psychoeducation and support groups within the Center

　　Perform all other duties and responsibilities as required

　　Participate in and lead interdisciplinary review of and coordination around complex patients

　　Maintain patient confidentiality in accordance with HIPAA

　　Document patient encounters in medical record system in a timely manner

　　Follow general policies related to fire safety, infection control and attendance

　　Use your skills to make an impact

　　Required Qualifications

　　Registered Nurse (RN license)

　　Minimum of 4 years of experience working in human services and navigating community-based resources

　　Preferred Qualifications

　　Familiarity with state Medicaid guidelines and application processes preferred

　　Experience working with patients with behavioral health conditions and substance use disorders preferred

　　Prior experience conducting home visits and knowledge of field safety practices preferred

　　Skills/Abilities/Competencies Required

　　Advanced clinical acumen

　　Ability to multi-task in a fast-paced work environment

　　Flexibility to fluidly transition and adjust in an evolving role

　　Excellent organizational skills

　　Advanced oral and written communication skills

　　Strong interpersonal and relationship building skills

　　Compassion and desire to advocate for patient needs

　　Critical thinking and problem-solving capabilities

　　Working Conditions

　　This role has a mobile presence, involving travel to patients' homes, treatment facilities and community-based settings, and assigned clinics to facilitate connections.

　　Workstyle: Combination in clinic and field, local travel to meet with patients

　　Location: Must reside in the Ft. Pierce/Lake Okeechobee area

　　Hours: Must be able to work a 40 hour work week, Monday through Friday 8:00 AM to 5:00 PM, over-time may be requested to meet business needs.

　　Tuberculosis (TB) screening : This role is considered member facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

　　Driver's License, Reliable Transportation, Insurance This role is part of Humana's Driver safety program and therefore requires an individual to have:

　　a valid state driver's license,

　　proof of personal vehicle liability insurance with at least 100/300/100 limits,

　　and a reliable vehicle.

　　Benefits

　　Health benefits effective day 1

　　Paid time off, holidays, volunteer time and jury duty pay

　　Recognition pay

　　401(k) retirement savings plan with employer match

　　Tuition assistance

　　Scholarships for eligible dependents

　　Scheduled Weekly Hours

　　40

　　About us

　　About Conviva: Conviva Care Centers provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana's Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

　　Equal Opportunity Employer

　　It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

　　Equal Opportunity Employer

　　It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. https://www.eeoc.gov/sites/default/files/migratedfiles/employers/eeocselfprintposter.pdf

　　If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact [email protected] for assistance.