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Care Navigator

3 months ago

Springfield, United States Commonwealth Care Alliance Full time
Why This Role is Important to Us

Commonwealth Care Alliance's (CCA) Care Navigation Specialist is primarily responsible for providing administrative support to the Care Team and CCA CA/MA/ MI members to ensure proper service provision, care coordination and member engagement. The Care Navigation specialist establishes rapport via telephonic interactions with members, caregivers, and providers in order to effectively meet the member's care coordination needs and support satisfaction with CCA services.

Supervision Exercised: No

What You'll Be Doing

  • Answer incoming member calls for non-clinical issues and questions with the goal of first call resolution with each interaction
  • Initiate outreach to members, vendors, providers, and/or suppliers to follow-up on non-clinical matters assigned by the Care Partner (e.g., including authorization status, DME status, and prescription assistance)
  • MA/MI only : Assist members with DME and supply questions, coordinate with DME and Supply Procurement Unit (DSPU) and any other relevant department(s)
  • Assist members with authorization questions, coordinate with relevant department(s) within CCA, or contracted IPAs
  • Assist members with appeals and grievances status, coordinate with Appeals and Grievances department (A G) and any other relevant department(s)
  • Assist members with scheduling post-assessment PCP or specialty appointments; follow-up to ensure members attended appointments
  • Educate members about their benefits and how to access them, coordinating with the Contact Center/Member Services team
  • Help members schedule transportation to medical and social appointments. Maintain proper documentation in member's chart.
  • Assist with fall log and Social Determinants of Health (SDoH) assessment completion
  • Support engagement and member education activities through outbound call and mail campaigns
  • Attend morning huddles and team meetings (as required)Additional duties as requested by supervisor
Working Conditions:

Standard office conditions. Eligible to hybrid remote work, with time spent in community, member-facing
  • Must be able to come to the local CCA office in the event CCA phone system is unavailable from remote work location
  • Must have strong internet signal at remote work location
  • Must be able to come to the local CCA office for administrative activities and scheduled meetings on a regular basis
  • May require meetings across the state of (MA / CA / MI )
What We're Looking For

Required Education:
  • Associate degree or a minimum of 2+ years of applicable experience
Desired Education:
  • Bachelor's degree preferred
Required Experience:
  • 2+ years office/administration
Desired Experience:
  • Experience working in a health plan, medical group, health-related facility or medical/DME supplier a plus
Required Knowledge, Skills Abilities:
  • Excellent critical thinking and troubleshooting skills
  • Strong customer service and problem-solving skills
  • Ability to work in multiple systems, often simultaneously
  • Clear, concise, and effective oral and written communication
  • Strong time management and demonstrated ability to work independently
  • Flexibility to adapt to business needs
  • Motivated team player
  • Excellent organizational skills
  • High attention to detail and accuracy
  • Basic arithmetic skills required
  • Proficiency in Microsoft Office Suite
Desired Knowledge, Skills Abilities:
  • Knowledge of medical terminology
Required Language(s):
  • English
Desired Language(s):
  • Spanish/Vietnamese preferred