Regional Director of Care Navigation; On-Site or Remote

Regional Director of Care Navigation (On-Site or Remote)

The Occu Net Company is an innovative company striving to reduce the cost of healthcare. We are a passionate group of people that care about affordable access to healthcare without sacrificing experience. We strive to make healthcare more intelligent, streamlined, and cost-effective. We offer industry-leading capabilities on negotiations-driven levers to contain rising healthcare costs while taking an experience-centric approach improving the health and well-being of those we serve.

We pride ourselves on our tight knit culture based on the ‘outward mindset’ philosophy, emphasizing empathy, mutual respect, and seeing each other as “whole people.” We have an ambitious vision and are growing quickly. We are seeking team members who are excited about our growth, seeking to thrive in a fast-paced environment, and enthusiastic about developing their skills and career alongside us.

Job Title
:
Regional Director of Care Navigation

Job Summary
:
As the Regional Director of Care Navigation, you will provide members with exceptional support by delivering high-quality, professional, and efficient service. You will also liaise with members and providers to assist in the coordination of care related to medical access complexities.

About The Occu Net Company (TOC):
The Occu Net Company is an innovative healthcare cost‑containment organization committed to improving access to affordable, high‑quality healthcare. We pride ourselves on an outward‑mindset culture that values empathy, respect, and seeing one another as whole people. Our team thrives in a fast‑paced, growth‑oriented environment where continuous learning and collaboration drive our success.

What it’s Like to Work Here
:
At Occu Net, you matter like we matter! Our team members share a positive attitude, an outward mindset, problem-solving abilities, and patience, enabling them to provide excellent customer service even during challenging situations. Our culture, plus continuous opportunities for growth, has resulted in an industry-low turnover rate. Don’t miss out on this rare opening with us!

A Day in the Life
:

As a Regional Director of Care Navigation, you will:

• Answer incoming calls and support members in scheduling appointments and accessing appropriate care.
• Maintain open, continuous communication between members and providers.
• Research accepting physicians or facilities based on plan design, member needs, and access barriers.
• Partner closely with Account Management, Contracting, Advocacy, Pre-Neg, and TPA teams to resolve access issues.
• Own the end-to-end member experience—from intake through resolution ensuring timely follow up, documentation, and clear next steps.
• Make outbound calls to providers, clients, and partners to gather information, educate stakeholders, and provide updates.
• Attend training and team meetings to stay current on workflows, tools, and plan updates.

Duties & Responsibilities
:

Member Advocacy & Support

• Acknowledge frustration, build trust, and help members confidently navigate their benefits.
• Own each case through resolution with proactive updates and follow‑through.
• Document all interactions thoroughly and accurately to ensure continuity of care, compliance, and quality.

Provider Communication & Problem Solving

• Liaise professionally with providers to clarify plan details, payment processes, and network structure.
• Navigate provider pushback with calm, respectful communication.
• Identify accepting or RBP‑friendly facilities and provide alternative options when needed.
• Coordinate Single Case Agreements (SCAs) or escalations based on internal criteria.
• Investigate delays or barriers that threaten timely care and act decisively to overcome them.

Operational Excellence

• Follow established workflows, boundaries, and escalation protocols with precision.
• Use internal research tools (OnPoint, PON, provider lookup systems) to verify provider options.
• Prioritize inquiries based on urgency, member risk, and available details.
• Collaborate across departments to establish processes that remove barriers to care.
• Uphold compliance standards, including HIPAA and Department of Labor guidelines.
• Maintain…