Elder Services of the Merrimack Valley
  • 21-Nov-2018 to 18-Dec-2018 (EST)
  • LTSS Community Partner
  • Lawrence, MA, USA
  • Full Time

    Elder Services of the Merrimack Valley, Inc.                                                                Northeast Independent Living Program


Job Purpose: The MVCP Navigator will ensure that members/enrollees of an Accountable Care Organization located in the Merrimack Valley receive comprehensive and coordinated care through the continuum of care. This position will help facilitate the integration of support services into care plans and assist the members/enrollees, their caregivers and the Primary Care Team in navigating the network of support and information services available.


Duties and Responsibilities

Essential Job Functions:

  • Conduct initial and ongoing assessments in the member's home environment for new ACO members/enrollees.
  • Timely and accurate completion of required assessment tools, data entry and documentation.
  • Collaborate with the member/enrollee and ACO team to develop a Personal Care Plan that best meets the members'/enrollees' needs, preferences and other applicable factors.
  • Assists the member/enrollee in identifying available public, private and informal supports that will meet their long term care needs and preferences.
  • Completes data input in appropriate databases, which includes demographic data and program/services documentation. Finds resources and services in the community that support members/enrollees, independence, wellness, and goals of recovery.
  • Monitors the outcomes of the developed Personal Care Plans.
  • Educates members/enrollees on community related programs and activities.
  • Attends and participates in all mandatory meetings and trainings, including Interdisciplinary Care Team meetings with the ACOs.
  • Maintain knowledge of, and carefully follow, all applicable federal and state compliance requirements and regulations.
  • Committed to ensuring the member's/enrollee's voice, needs and preferences are supported to remain independent in the community. Promotes and values members dignity of risk and right to fail in a person centered model of care.
  • Works as an effective team member in a collaborative manner to ensure continuity of adequate and appropriate information sharing.
  • Other duties as assigned.


  • Bachelor's Degree in Human Services or related field desired. May be substituted with equivalent experience as a person living with a disability.
  • Three to five years of experience in the human service field and experience in coordinating services for one or more of the target populations.
  • Experience working with individuals with chronic health conditions and physical, developmental and mental disabilities.   
  • Disability and cultural competence in the area of mental health stigma and barriers to independence.
  • Ability to travel independently & reliable transportation required.
  • Excellent computer skills required.
  • Strong written and verbal skills. Well organized, ability to multitask and strong attention to detail.
  • Bilingual in English, Spanish or Khmer preferred
  • An enthusiastic team player who adapts well to on-going change and welcomes new challenges.
  • Model integrity, personal and professional ethics and maintain confidential member/enrollee and organizational data.


Please Submit a Cover Letter and Resume

37.5 Hours


Elder Services of the Merrimack Valley
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