Social Care Navigatgor (SCN)

B. Social Care Navigation

• 1.
• For members with positive screens, conduct a full Eligibility Assessment (EA) in Unite Us to determine eligibility for Enhanced HRSN Services (housing, nutrition, transportation, enhanced care management).
• 2.
• Use the Enhanced Services Member File (ESMF) — received monthly via Unite Us —alongside EA findings to determine applicable Enhanced HRSN Service eligibility; assess relevant Social Risk Factors for each identified unmet need.
• 3.
• Verify Medicaid Managed Care enrollment in real time using MEVS/ePACES prior to Enhanced HRSN Service referral.
• 4.
• Navigate Medicaid FFS members to existing federal, state, and local resources; FFS members are not eligible for Enhanced HRSN Services.
• 5.
• Issue closed-loop referrals in Unite Us: connect eligible MMC members to HRSN service providers in the Healthy Alliance network, track referral status, and follow up to confirm service delivery.
• 6.
• Manage service duplication checks; coordinate with MCO case managers when potentially duplicative services are identified; document duplication check activity under Enhanced Care Management billing.
• 7.
• Update member addresses and transfer workflows when members relocate across SCN regions.

C. Social Care Plans

• 1.
• Develop and maintain a Social Care Plan in Unite Us for each member receiving Enhanced HRSN Services; plans are longitudinal and must be revisited and updated as services are rendered and needs are met.
• 2.
• Ensure Social Care Plans reflect member-identified goals, household considerations, and relevant Social Risk Factors.
• 3.
• Coordinate re-authorizations for services approaching or exceeding initial service duration limits.

D. Enhanced Care Management

• 1.
• Provide intensive social care coordination for members belonging to Enhanced Populations: Medicaid High Utilizers, NYS Health Home enrollees, pregnant and postpartum persons, criminal justice-involved individuals with chronic or behavioral health conditions, high-risk children under 18, and persons with IDD, SMI, or SUD.
• 2.
• Conduct multi-program service duplication checks and MCO contact outreach; bill coordination time under Enhanced Care Management as directed by Healthy Alliance billing protocols.
• 3.
• Liaise with Health Home care managers (including TruCare’s own CM team) when members are dually enrolled, to ensure coordinated — not duplicative — service delivery.
• 4.
• Identify and communicate major life events to relevant partners to trigger timely re-screening and service adjustments.

E. Documentation, Billing & Compliance

• 1.
• Maintain accurate, complete, and timely documentation of all billable activities in Unite Us; documentation drives reimbursement —incomplete records = unbillable services.
• 2.
• Obtain and document member consent in compliance with HIPAA and SCN consent requirements prior to Eligibility Assessment and service referral.
• 3.
• Submit required information to support Healthy Alliance’s performance reporting, including Quarterly Performance Reports and Operational Indicator Surveys.
• 4.
• Adhere to all NYS OHIP SCN Operations Manual requirements (currently Version 7, January 2026) and Healthy Alliance network policies.
• 5.
• Participate in all required training: Unite Us platform training, OHIP/Healthy Alliance SCN training, and TruCare onboarding requirements.
• 6.
• Maintain CHRC background check clearance and comply with all NYS HCS requirements.