Prospective Member Navigator

4 days ago


Coconut Creek, Florida, United States Centers Plan for Healthy Living Full time

About Us:

We are committed to creating a seamless healthcare experience for our members and their families. Our goal is to provide guidance and support for healthy living.

Job Summary:

The Prospective Member Navigator conducts comprehensive assessments to determine eligibility and develops care plans for prospective members. This role involves timely completion of productivity and paperwork, as well as explaining managed long-term care benefits and services to prospects.

Key Responsibilities:
  • Assesses prospects via telehealth, completing comprehensive assessments (UASNY) to determine eligibility and initial plan of care.
  • Develops plans of care for prospects using NYIA's assessments.
  • Effectively completes the required assessment form (UASNY) and other CPHL necessary documents within established timeframes and in accordance with State and Federal guidelines.
  • Communicates plan benefits clearly and easily to prospects and referral sources.
  • Completes and submits thorough and high-quality documentation in a timely manner.
  • Alerts Supervisors regarding any issues encountered during an assessment.
  • Recognizes quality of care issues and escalates appropriately, communicating effectively with coordinators and supervisors as needed.
Requirements:
  • Education: Registered Nursing License.
  • Experience: Overall understanding of community-based care programs.
  • Certifications/Licensure: Registered Nursing License.
  • Knowledge and Skills: Solid clinical judgment, ability to problem solve in real-time, knowledge of MLTCP regulations, excellent communication and interpersonal skills.

Annual Salary: $72,000, dependent on experience.



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