Member Care Navigator

Job Summary

Enhanced Member Supports Unit In this role, you will assist in resolving patient/member concerns, providing appropriate education/instruction and maintaining patient/member satisfaction by providing the highest level of clinical support. Assists and educates patients/members about available services through motivational interviewing, problem solving, interpreting complex clinical problems, researching information, contacting providers and providing patient/member information. Assists patient/members with social determinants of health, special needs, and/or crisis situations by helping to identify the problem(s) through interviewing skills, identifying primary and secondary resources, by discussing options with the patient/member, and helping them decide on the plan of action.

Advocates for patient/member who are incapacitated by age, physical or mental illness or handicap, or who are otherwise unable to communicate with various service delivery systems effectively.

Job Summary

Enhanced Member Supports Unit In this role, you will assist in resolving patient/member concerns, providing appropriate education/instruction and maintaining patient/member satisfaction by providing the highest level of clinical support. Assists and educates patients/members about available services through motivational interviewing, problem solving, interpreting complex clinical problems, researching information, contacting providers and providing patient/member information. Assists patient/members with social determinants of health, special needs, and/or crisis situations by helping to identify the problem(s) through interviewing skills, identifying primary and secondary resources, by discussing options with the patient/member, and helping them decide on the plan of action.

Advocates for patient/member who are incapacitated by age, physical or mental illness or handicap, or who are otherwise unable to communicate with various service delivery systems effectively.



Job Duties

• Serves as the primary contact for Enhanced Member Supports Unit, Behavioral Health and network for patients/members/providers.
• Assesses all clinical issues and concerns to assure accurate information is provided promptly to patient/member/provider.
• Manages crisis situations with patients/members and triages appropriately.
• Provides assistance with concerns related to social determinants of health.
• Completes resolution for all patient/member/provider concerns and inquiries.
• Provides daily support and direction to patient/member/provider services staff.
• Obtains data on callers’ needs for use in monthly statistical and activity reports.
• Communicates and coordinates with the appropriate internal department to resolve issues.
• Collects and records data on special needs organizations, facilities and services.
• Prepares, generates and appropriately disseminates letter communications to patients and members.
• Provides training within the team as needed.
• Explores covered benefits and community resources as applicable by line of business and product design.
• Provides team building resources to help direct peers to appropriate policies and procedures to assist patients/members/providers.
• Completes outbound calls to patients/members/providers to resolve complex eligibility issues.
• Navigates multiple computer programs while assisting patient/member/provider.

• Bachelor's Degree in a related field of study (Social Work, Healthcare Administration, Psychology, Public Health, Human Services, or a related healthcare/behavioral health field)
• Minimum of 1 year of related work experience

• Full benefits (health, dental and vision) starting on day one
• Three medical plan choices, including an expanded network for out-of-area employees and dependents
• Pre-tax savings plans with healthcare and dependent care flexible spending accounts (FSA) and a health savings account (HSA) with employer contribution
• Company-paid life insurance, short-term disability, and long-term disability coverage
• 401(k) plan that includes automatic…