JOB SUMMARY

The Member Navigator works directly with members who have chronic health issues, gaps in care, or are difficult to engage; guides these members through the health care system and works to overcome non-clinical obstacles that prevent them from receiving the care and treatment they require. Works closely with teams across multiple departments, provider offices, and community resources to foster timely delivery of quality, accessible health care services.

QUALIFICATIONS

• EDUCATION - Associate’s or 2 years of work experience above the minimum qualification
• EXPERIENCE - 3 Years of Experience

• Reaches out to and engages members telephonically and other appropriate methods. Establishes a trusting relationship with members, and works with the members to assess the barriers that are preventing them from receiving the care and treatment they require. Serves as member advocate and facilitator in overcoming identified barriers to care. Creates connections between members, health care providers, community resources and case management staff, as needed.
• Conducts member screenings and refers to case management if clinical needs are identified.
• Maintains appropriate documentation of member contact, referrals and outcomes. Verifies and updates member demographic information.
• Performs quality assurance reviews and trend study; initiates process corrections and training requirements, and sets goals for improvements. Conducts regular assessments of the navigation program; identifies weaknesses and works across health plan departments to create and deploy strategies to improve program quality.
• Builds partnerships with teams across multiple departments, provider offices and community resources to foster timely delivery of quality, accessible health care services.
• Continuously expands knowledge and understanding of health plan services and benefits, provider network, and community resources.
• Develops scripts, process flows, etc. for member outreach.