Healthcare Navigation Specialist

2 weeks ago


Dallas, Texas, United States Axelon Full time
Position Overview:
In this role, you will be responsible for developing, evaluating, and coordinating care management initiatives tailored to the needs of our members, ensuring the delivery of high-quality and cost-effective healthcare outcomes.

Key Responsibilities:
1. Assess and address member needs, identifying barriers to care and available resources to recommend effective plans for optimal outcomes.
2. Collaborate in the creation of personalized care plans and ongoing service strategies, while identifying necessary providers, specialists, and community resources.
3. Offer psychosocial support and resource guidance to members and caregivers, facilitating access to local services such as employment, education, and housing.
4. Ensure timely communication between members, families, and care provider teams to guarantee accessibility to required services.
5. Monitor progress towards care plan goals, collaborating with healthcare providers for necessary revisions and referrals.
6. Maintain comprehensive documentation of member information and care management activities to comply with regulatory standards.
7. Conduct on-site assessments as needed and provide education to care managers and members regarding healthcare procedures and benefits.

Work Environment:
This position operates within a call center framework, focusing on inbound calls to assist and educate members regarding their benefits and services.

Performance Metrics:
- Adherence Rate: 90% or above
- Quality Assurance: 95% or above

Qualifications:
- Bachelor's degree and 2-4 years of relevant experience, or equivalent experience in a similar role.
- Preferred clinical licensure from an accredited nursing program.
- Experience in call center operations and familiarity with medical insurance, particularly with the aging, blind, and disabled populations.
- Strong customer service skills; bilingual candidates are preferred.

Training and Development:
New hires will receive necessary equipment and system access on their first day, followed by comprehensive training to ensure proficiency in their role. Continuous support will be provided through mentorship and ongoing training opportunities.

Software Proficiency:
Familiarity with Microsoft Office Suite, Avaya, Zoom, and Teams is required.

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