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Healthcare Navigator
1 month ago
Job Summary:
This role ensures that members with complex medical and/or psychosocial needs have access to high-quality, cost-effective healthcare. The Medical Case Manager will assist in the holistic assessment, planning, arranging, coordinating, monitoring, and evaluation of outcomes and activities necessary to facilitate member access to healthcare services.
Key Responsibilities:
- Communicate effectively with members, healthcare providers, and internal stakeholders to ensure seamless care coordination.
- Assess member needs and develop individualized care plans to address complex medical and psychosocial issues.
- Collaborate with healthcare providers to ensure timely and effective care delivery.
- Monitor member progress and adjust care plans as needed to achieve optimal health outcomes.
- Stay up-to-date on relevant healthcare policies, procedures, and regulatory guidelines to ensure compliance.
- Participate in interdisciplinary team meetings to facilitate coordination of member care and resources.
- Foster effective relationships with healthcare providers, members, and internal stakeholders to ensure successful care coordination.
Requirements:
- Bachelor's degree in nursing or social work, or equivalent experience.
- Minimum 3 years of experience in case management or a related field.
- Strong communication and interpersonal skills.
- Ability to work independently and as part of a team.
- Knowledge of healthcare policies, procedures, and regulatory guidelines.
Preferred Qualifications:
- Experience working with high-risk populations or complex medical conditions.
- Case management certification.
- Bilingual or multilingual skills.
Highmark Health is an Equal Opportunity Employer:
We are committed to diversity, equity, and inclusion in the workplace. We prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation, or any other category protected by applicable federal, state, or local law.
