PG Health Connect Navigator

Mary's Center is committed to promoting diversity, equity and inclusion (DEI) within our organization and the communities we serve. We embrace diversity of experiences, ideas, and individuals, and seek to bring a diverse group of candidates to the table.

Position Summary

The PGHC Navigator delivers education, outreach and in person-assistance with attention to the particular communication, cultural, and linguistic needs of the population served. Training and certification are provided by Prince George's County Health Connect program. The role of the Navigator is to provide participants with fair and impartial information and services that help to guide them through applying for and enrolling in health coverage. Navigators provide education about a participant's options for health coverage (including both Medicaid and qualified health insurance plans) and health services. Navigators also assist participants with making changes to their account in the event of income fluctuations or changes in household, and renewing coverage during the appropriate renewal periods. In the event that a participant has grievance, complaint, or question, Navigators provide referrals to the appropriate entity. Navigators also connect participants to a range of community resources, both within the Exchange (e.g., the Call Center and website) and beyond. This position will require occasional evenings or weekends to cover events, the call center, and other activities.

Reportability

This position will be reported directly to the Entitlement Manager.

Essential Duties and Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Insurance Screening and Enrollment

• Deliver general education about the Affordable Care Act and the Exchange.
• Assist customers with opening or accessing an account with the Exchange.
• Explain affordability programs, Qualified Health Plans, Essential Health Benefits, and rights when using Insurance.
• Explain Medicaid, MCHIP, and other insurance programs in the region as identified.
• Assist customers with their application and determine eligibility for premium tax credits and Medicaid.
• Assist customers with understanding web-based decision tools to help narrow the choices for qualified health plans.
• Ensure customers know about their health plan options through the Exchange and help them filter and sort based on those options.
• Refer customers with appeals, grievances, and complaints to the appropriate agency.
• Make referrals as needed to the appropriate Medicaid program, a broker, the Exchange, or government and community resources as needed.
• Explain to customers when life changes can be reported and when renewal will be needed.
• Provide all services in a manner that is culturally and linguistically relevant to the customer.

Administrative and Outreach

• Achieve certification and maintain expertise through continuing education.
• Learn & understand the Q-Matic system at the service center and the workflow at the service centers.
• Rotate at service sites if needed.
• Accurately track and record activities for reporting to the Exchange.
• Assist participants at the PGHC Call Center.
• Must be available to accommodate evenings or weekends scheduled community outreach and enrollment events.

General

• Provide and model outstanding customer service to the customers and the public.
• Follow HIPAA confidentiality guidelines.
• Provide reports as identified to the Entitlement Manager or others as needed.
• Perform other duties as determined necessary by the Entitlement Manager.

Qualifications

The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Knowledge, Skills & Abilities -

• A bachelor's degree or an associate degree with equivalent experience is required.
• Must have strong interpersonal skills and collaborate effectively with community members.
• A fundamental understanding of health insurance and health service delivery.
• The ability to recognize differences in culture, language, and learning styles.
• The capacity to explain and summarize detailed and complex concepts clearly.
• Experience working directly with the community, along with knowledge of public benefits programs and eligibility standards in Maryland and the District.
• Familiarity with public or private health programs is beneficial.
• Proficiency in using the internet, Microsoft and other office programs is essential.
• A comprehensive understanding of patient confidentiality issues and compliance with HIPAA regulations.

Language Requirement - Must have the ability to negotiate/provide advocacy and communicate effectively in English and Spanish as used by participants.

Physical Demands - Regularly required to sit; frequently required to reach with hands and arms, walk, stoop, kneel, crouch, talk or hear; must be able to lift objects up to twenty-five (25) pounds.

Work Environment - Site locations Hyattsville, Landover and Temple Hills, MD Department of Social Service Center with a moderate noise level. May be exposed to wet and/or humid conditions, extreme cold and heat due to outside weather conditions.

The Benefits:

• Health Insurance: medical, dental & vision - plus retirement options through 403(b) contribution and investment opportunities
• 25 days of paid leave annually (in addition to paid holidays), plus 5 educational days
• Tuition reimbursement of $2000/year towards education assistance and professional development
• Transportation subsidy via metro & bus
• Employee Assistance Program (EAP)