Care Navigator - REMOTE

Job Title:

Care Navigator

Job Description

This role develops, assesses, and coordinates care management activities based on member needs to support quality, cost-effective healthcare outcomes. The Care Navigator creates or contributes to personalized care and service plans, connects members with appropriate providers and community resources, and educates members and their families or caregivers on available services and benefit options. Through advocacy and care coordination, this position helps members improve access to healthcare and receive appropriate, high-quality care.

Responsibilities

+ Evaluate members' needs, identify barriers to care, assess available resources, and recommend and facilitate a care plan that supports the best possible outcomes.

+ Develop or contribute to personalized care and service plans, including ongoing updates, and identify appropriate providers, specialists, and community resources needed to support member care.

+ Provide psychosocial and resource support to members, caregivers, and care managers to help them access local services such as employment, education, housing, food, participant-directed services, independent living, justice-related resources, and foster care, based on service assessments and plans.

+ Coordinate, as appropriate, between members, families or caregivers, and the care provider team to ensure that identified care and services are accessible in a timely manner.

+ Monitor progress toward care and service plan goals and track changes in member status or condition; collaborate with healthcare providers to revise care or service plans as needed and refer members to care management for further evaluation when appropriate.

+ Collect, document, and maintain all member information and care management activities in accordance with current state, federal, and third-party payer regulations.

+ Perform on-site visits, when required, to assess member needs and collaborate with providers or community resources.

+ Provide education to care managers, members, and families or caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits.

+ Support crisis intervention and crisis management efforts as needed, ensuring members receive appropriate and timely support.

+ Use care management platforms or healthcare CRM systems to manage caseloads, document interactions, and track member outcomes.

+ Engage in telephonic outreach to members as part of care navigation, care coordination, and population health initiatives.

+ Work effectively within a call center healthcare environment to respond to member needs and support care management programs.

+ Perform other duties or responsibilities as assigned to meet member and business needs.

+ Comply with all organizational policies, procedures, and standards.

Essential Skills

+ Bachelor's degree in Social Work, Psychology, Human Services, Behavioral Health, or a related field.

+ Minimum 1 year of experience in Care Navigation, Care Coordination, Case Management, Member support, Population Health, Behavioral Health programs, or health plan/member services involving telephonic outreach.

+

Experience with care management, care coordination, and care navigation for diverse member populations.

+ Proficiency using care management platforms or healthcare CRM systems to document and track member interactions and outcomes.

+ Experience managing a caseload in a healthcare or behavioral health setting.

+ Experience in behavioral health, including working with members with psychosocial or behavioral needs.

+

Experience with telephonic outreach to engage members, coordinate care, and provide education.

+ Crisis intervention and crisis management skills to support members experiencing urgent or complex…