Job Description

Health Navigator

Healthcare Services company looking for a Health Navigator to join their dynamic team. As a Health Navigator, you'll be the frontline of the Commercial Care Team, guiding members through their healthcare journey and making a positive impact on their lives. In this role your primary focus will be on:

• Site of Care Improvement: Ensuring members receive the right care at the right place.
• Readmission Prevention: Providing crucial pre and post-care support to keep members healthy and out of the hospital.
• Pediatric Wellness: Promoting wellness appointments to ensure our youngest members thrive.

Job Responsibilities

• Conducting educational telephone calls advising members of available benefits, services, and programs; completing health needs assessments, and referring members to appropriate health management programs.
• Reaching out to members with identified gaps in care; encouraging compliance and assisting with locating providers and scheduling appointments.
• Managing system work queues; screening members for eligibility, prior case activities, claims, customer service inquiries, and authorization history; assigning members to clinical teams for call outreach and intervention.
• Facilitating research and analysis of inquiries/complaints related to processes, program designations, and other program-related matters.
• Working overtime as needed.
• Immunizations and medical tests may be required.
• Digital literacy assessment required.

Job Qualifications

• Associates Degree in education, communication, health-related field, or equivalent work experience.
• 2+ years in a customer service support role.
• Ability to work independently or in a team environment with shared responsibility.
• Proficient interpersonal and organizational skills.
• Strong decision-making and problem-solving abilities.
• Self-motivated with the ability to manage multiple tasks and prioritize effectively.
• Effective time management and communication skills.
• Knowledge of medical terminology.
• Proficiency in Spanish is not required but is strongly preferred.

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