CARE MGMT NAVIGATOR

Department: CARE MANAGEMENT SERVICES

Job Summary

The Care Managment Navigator provides support to the Care Managers and other staff in the resolution of member related issues.
Communicates with members and their families regarding information about Managed Long Term Care (MLTC) services. Provides summary reports, analysis and support for care coordination related activities. Participates in non-clinical customer service for members enrolled in the VNS Health Plans MLTC plan in collaboration with Care Coordination department and other healthcare professionals. Works under the general supervision of the Manager of Ancillary Services.

Core Job Responsibilities

Educates potential members/community representatives on plan features, plan benefits, and program
admission requirements.
Coordinates telephonic intake and responses to both clinical and non-clinical customer service issues.
Identifies nature of issue, independently responds to and resolves non-clinical issues and complaints, and
escalates clinical issues to appropriate department and staff.
Assists in monitoring member satisfaction through phone calls to verify service, answering questions and
providing information. Documents member service issues, identifies trends and recommends potential
solutions.
Maintains expertise in VNS Health Plans MLTC benefits, network and organization structure. Acts as a
resource to members to guide them in accessing their benefits.
Places orders or referrals for services and follows up to ensure services are scheduled and provided.
Processes and monitors invoices for payment.
Serves as a resource for MLTC Care Manager and other staff in the resolution of member-related issues.
Establishes effective customer-focused working relationships with members, physicians and providers of long term care services.
Audits system-generated reports, reconciles data, and distributes reports to management for review.
Participates in interdisciplinary team meetings and provides input on customer service related activities.
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
Ensures compliance with the VNS Health Plan’s policies and procedures as well as all Federal and State
regulations.
Provides administrative support to care coordination staff
Performs related duties as assigned.

Education/Experience Requirements

REQUIRED:

High School diploma.
One year of customer service experience.
Excellent telephone skills and ability to clearly communicate verbally and in writing.
Proficient with computers, email.

PREFERRED:

Associate’s degree in a healthcare related field.

Licensure/Certification Requirements

Disclaimer

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.
Successful candidates might be required to undergo a background verification with an external vendor.

Job Details

Req Id 93189
Department CARE MANAGEMENT SERVICES
Shift Days
Shift Hours Worked 7.50
FTE 0.94
Work Schedule HRLY NON-UNION-8 HR
Employee Status A1 - Full-Time
Union Non-Union
Pay Range $18.69 - $25.19 Hourly