MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The primary function of the Quality Management (QM) Health Navigator is to outreach members missing important health screenings (i.e., HEDIS/QARR gaps in care) to assist in coordinating needed appointments for a variety of clinical and social services and ensuring maintenance medications are filled regularly. The QM Health Navigator will serve as a source of empowerment for MetroPlusHealth members, educating on the importance of, and motivating them to complete, needed services and providing support as the member navigates the health care system, all with the goal of maximizing performance in the organization's quality reporting programs and health outcomes.

The QM Health Navigator will also play a vital role in identifying and collecting data on the existence and prevalence of healthcare barriers. In addition to addressing the barriers with the member, this data will be used to inform future planning for care access, health equity and needed network expansions and shape the organization's overarching quality strategy, helping to ensure high-quality of care to all New Yorkers serviced by MetroPlusHealth.

Each QM Health Navigator will be responsible for one of the following domains of care: Women's Health, Chronic Conditions or Child/Adult Screenings and Immunizations.

• Telephonically outreach members to assist them with appointments for primary and specialty care, educational classes, and transportation.
• Assist members with filling maintenance medications regularly and on-time. This includes helping members secure new scripts/refills and assisting them in enrolling in home delivery services.
• Educate members on the importance of regularly receiving needed services using evidence-informed approaches. Coach and motivate them to engage in care.
• Develop and maintain effective working relationships with members and providers.
• Collect data on the existence and prevalence of healthcare barriers and social needs. Assist members with navigating the healthcare system and provide basic benefit information as needed.
• Promote communication with the Care Management team and other internal departments to ensure continuity of care and to foster member satisfaction.
• Share observations and provide feedback regarding workflow to ensure continuous quality improvement.
• Maintain accurate and complete documentation of required information in compliance with risk management and regulatory requirements.
• Perform data entry of medical information; maintain tracking process and reports.
• Comply with all orientation requirements, annual and other mandatory training, organizational and departmental policies and procedures and actively participate in the evaluation process.
• Maintain professional competencies as a Quality Management Health Navigator.
• Perform ad-hoc projects as assigned

• High school diploma or GED required. Bachelor's Degree preferred.
• 3+ years of experience in client relations/providing customer service, preferably in the medical field working with the health needs of patients
• Working knowledge of medical terminology and abbreviations.
• Must know how to use Microsoft Office applications including Word, Excel, and Outlook.
• 1-3 years Managed Care Experience, preferably in Care Coordination, a plus.
• Experience in Motivational Interviewing is a plus
• Experience as a Medical Assistant or Licensed Vocational Nurse is a plus.
• Bilingual candidates are strongly preferred.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical/Analytical Skills
• Teamwork
• Written/Oral Communications
• Strong customer service skills to coordinate service delivery including attention to members/caregivers, sensitivity to concerns, proactive identification and rapid resolution of issues to promote positive outcomes for members.

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