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Care Navigator
3 months ago
Job Description: The Risk Adjustment Care Navigator engages Health Plan members and schedules Risk Adjustment appointments
ROLE AND RESPONSIBILITIES
• Engages Health Plan member and employs professional techniques during verbal communications, electronic correspondence, and text-based interactions with each member.
• Assists Health Plan Members with scheduling appointments with the Nurse Practitioners (NP’s).
• Update and maintain accurate documentation of each member encounter in the electronic health record (EHR).
• Accurate documentation of appointments.
• Proper execution of member referral/concerns/grievances when applicable.
• Document timely member observations requiring administrative notification of any critical member issues/concerns.
• Follows all Policies and Procedures of SCCP.
• Compliant with Performance Goals / Contract Deliverables.
• Participates in all SCCP mandatory and CMS regulatory training.
• Attends all staff meetings – in person or telephonic (if unable to attend, responsible for knowledge of content). • Abide by principles and laws related to confidentiality. • Demonstrate respect for individual diversity (culture, ethnicity, gender, race, religion, age, economic status). • Interact with staff and members to optimize workflow efficiency. • Other duties as assigned by Direct Report.
QUALIFICATIONS AND EDUCATION REQUIREMENTS
• High School Diploma or Equivalent Required.
• Minimum of 1 year of Call Center Representative Experience Preferred.
• Minimum of 2 years in a Customer Service Role Required.
PREFERRED SKILLS
• Excellent verbal communication skills.
• Ability to interact with health care professionals in a professional manner. • Computer Literate – Word, Google Doc and Excel.
• Able to multi-task, manage time and set priorities.
• Able to remain coachable and teachable at all times.
- Bilingual Preferred
