Health Navigator

Job Profile Summary

Supports area clinical team and serves as a proactive resource for members related to disease prevention and benefit education.

Job Responsibilities

• Conducting educational telephone calls advising members of available benefits, services and programs; completes health needs assessment, and refers members to population health management programs as appropriate.
• Reaching out to members with identified gaps in care; encouraging and motivating them to become compliant; offering assistance in locating providers and appointment scheduling.
• Managing system work queues; screening identified members for eligibility, prior case activities, recent claims, customer service inquiries and authorization history; assigning members to clinical team for call outreach and intervention.
• Facilitating research and analysis of inquiries and / or complaints related to processes and designations, member lost incentives, and other program related inquiries.
• Work overtime as needed
• Various immunizations and / or associated medical tests may be required

Job Qualifications Education

Experience

Skills / Certifications