Job Summary:
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.

Responsibilities:

• 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

Qualifications:
-

• Associate degree or a minimum of 2 years of applicable experience required, Bachelor's degree preferred
• 2 years office/administration required, 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

Language(s):

• English required, Spanish/Vietnamese preferred

Joining our team as a Care Navigator offers the opportunity to make a meaningful impact on patients' lives while working in a collaborative healthcare environment.

Job Type: Full-time

Pay: $55,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Referral program
• Vision insurance

Medical specialties:

• Home Health

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• No weekends

Work setting:

• Outpatient
• Telehealth

Experience:

• EMR systems: 1 year (Preferred)
• prior authoriation: 1 year (Preferred)

License/Certification:

• Certified Medical Assistant (Preferred)

Willingness to travel:

• 25% (Required)

Work Location: On the road