Gainesville, Georgia
Nashville, Tennessee
Bel Air, Maryland
Gainesville, Georgia
Los Angeles, California
Gainesville, Georgia
Posted: 02-Jan-25
Location: Dallas, Texas
Categories:
Internal Number: 24014987-1
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.
ESSENTIAL FUNCTIONS OF THE ROLE
- 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.
KEY SUCCESS FACTORS
- Experience as a community health advocate and/or navigator.
- Naturally attuned to the people and community being served.
- Knowledgeable about the environment, healthcare system and community resources.
- Skilled in developing and maintaining effective relationships with providers, administrative and professional staff within the health plan and across the system to foster timely delivery of quality, accessible health care services.
- Excellent verbal, written and electronic communication skills required.
- Proficient in all Microsoft applications, including Word, Excel, and PowerPoint.
- Skilled in data collection, research and report writing.
- Able to work autonomously with minimum supervision, in a fast paced environment with clear focus on program priorities.
- Able to exercise initiative, judgment, problem solving and recommendation making skills.
- Excellent time management skills with the ability to meet deadlines.
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - Associate's or 2 years of work experience above the minimum qualification
- EXPERIENCE - 3 Years of Experience