Care Management Navigator

1 month ago

Portland, United States Martins Point Health Care Full time

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary
The Care Management Navigator is responsible for providing non-clinical support to the Care Management (CM) Team including but not limited to program outreach, enrollment support, and administrative support. This role supports the operation of the Care Management team through assisting members with navigation and selection of appropriate in-network providers, steerage from out of network providers to in-network providers and helps facilitate interaction with resources appropriate for the care and well-being of members. The Care Management Navigator will also perform operational/ regulatory/administrative and customer support activities to ensure day to day operational functions of the care management team are met in a timely and accurate manner in compliance with contractual standards set forth by CMS, Tricare, and NCQA.
Job Description

Key Outcomes:

  • Assesses program eligibility and information completeness for members referred according to program eligibility standards.
  • Outreaches members identified for care management to introduce care and disease management programs, complete initial screening and engage new members prior to assigning to a care manager
  • Assists members with navigating appropriate care per benefits
  • Assists with access to care, benefits, and resource management,
  • Manages all lines of communication (i.e., phone lines, email, fax, and work queues)
  • Collaborates with the care management team around member and provider
  • Assists with research for obtaining clinical information, discharge information, or clinical/health plan information that may be needed for care management
  • Maintains a list of provider information including validation of address, accepting new patients, and location and availability of specialty providers
  • Processes continuity of care requests for established members and locates appropriate in-network providers; refers to care management as appropriate.
  • Performs data entry into the electronic care management systems
  • Assists with tracking and trending data as needed.
  • Complies with all contract requirements and organizational/departmental standards regarding referrals, assessments, and provider/member communications.
  • Participates in process improvement initiatives, if needed.
  • Provides back up support for other non-clinical areas, as needed.
Education/Experience:
  • Associates Degree or equivalent combination of education and experience preferred
  • 2 years of managed care experience preferred
  • Experience as a medical assistant or community health worker required
  • Experience with care management/ community resources preferred
Required License(s) and/or Certification(s):
  • Medical Assistant or Community Health Worker Certification
Skills/Knowledge/Competencies (Behaviors):
  • Demonstrates an understanding of and alignment with Martin's Point Values.
  • Basic knowledge of medical terminology.
  • Basic knowledge of current healthcare benefits and managed care insurance plans.
  • Knowledge of CMS and NCQA regulations a plus.
  • Strong organizational skills (ability to prioritize and multi-task in a high-pressure environment while maintaining focus on organization objectives).
  • Ability to take direction from multiple individuals and prioritize tasks appropriately to meet deadlines.
  • Ability to handle confidential and sensitive information in a discreet and professional manner.
  • Effective customer service skills for use with both members and providers.
  • Demonstrated technical skills in use of office systems, electronic heath records, and databases.
  • Basic knowledge of Microsoft Word, Excel, PowerPoint, and Outlook
  • Ability to function independently.
  • Critical thinking: Can identify root causes and suggest creative solutions.
  • Takes appropriate initiative while soliciting input/advice appropriately.
  • Ability to collaborate with all internal departments and staff with dedication to customer satisfaction.
  • May need to be available on a phone queue between 8:00am and 4:30pm as needed to support the CM nurses and social workers.


There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org

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