What are the responsibilities and job description for the Clinical - Care Navigator Care Navigator position at Mindlance?
Job Description : Position Purpose :
Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan / service plan for members and educates members and their families / caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.
Education / Experience :
Requires a Bachelor's degree and 2 - 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
License / Certification :
Current state's clinical license preferredEvaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome
Develops or contributes to the development of a personalized care plan / service ongoing care plans / service plans and works to identify providers, specialists, and / or community resources needed for care
Provides psychosocial and resource support to members / caregivers, and care managers to access local resources or services such as : employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans
Coordinates as appropriate between the member and / or family / caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner
May monitor progress towards care plans / service plans goals and / or member status or change in condition, and collaborates with healthcare providers for care plan / service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
May perform on-site visits to assess member's needs and collaborate with providers or resources, as appropriate
May provide education to care manager and / or members and their families / caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits
Other duties or responsibilities as assigned by people leader to meet the member and / or business needs
Performs other duties as assigned
Complies with all policies and standards
Comments for Vendors :
EEO :
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority / Gender / Disability / Religion / LGBTQI / Age / Veterans."
Centene Job Description
Story Behind the Need - Business Group & Key Projects
- Health plan or business unit
- Team culture
- Surrounding team & key projects
- Purpose of this team
- Reason for the request
- Motivators for this need
- ny additional upcoming hiring needs?
Health Plan
Call Center
Would be working with MSC Department and assisting in taking calls for our STAR PLUS member.
Team is to cover and answer calls that come in through call center.
This is to cover the SCs who are out in LOA, FMLA and the openings we have open.
Self-starters, eager to learn, great customer service Typical Day in the Role
Compelling Story & Candidate Value Proposition
Everyday they will learn and speak to different members and network providers to assist them with their needs.
Experience of learning different Medicaid products
Candidate Requirements Education / Certification High school Diploma or GED. Preferred : BA in Social Work or Healthcare Mgmt, LVN, CNA, CMA, RT, Pharmacy Tech Licensure n / Preferred : CHW
Must haves : good attendance, call center background; worked with MCO insurance
Nice to haves : background in Service Coordination, and call center experience.
Disqualifiers : no call center experience, upcoming extended PTO / time off
Performance indicators :
Software Skills : Will be using various software on the job : Microsoft Office Suite, Avaya, Zoom, Skype
Best vs. average :
1 Customer service, call center experience 2 Computer knowledge, specifically Excel and other Office features (Teams, Outlook, etc...) 3 Insurance background. Candidate Review & Selection
Projected HM Candidate Review Date : 2-3 business days post-shortlisting Number and Type of Interviews : 1 Extra Interview Prep for Candidate : ny PTO that they may have coming up / time off Required Testing or Assessment (by Vendor) : n /
