Job description
The Health Navigator works under the guidance and direction of the FEP Team Lead to provide clinical support to the Customer’s population. The Health Navigator is responsible for outreaching and engaging to assigned populations to support clinical education and coordination, including but not limited to: wellness, gaps in care and utilization. Based on a clinical algorithm and department protocols, the Health Navigator is responsible for identifying candidates who have complex or ongoing needs and appropriately referring them to other programs / resources.
Duties and Responsibilities:
- 30% - Acts as the point person to collaborate with other departments to support the needs of their assigned population.
- 30% - Completes non-clinical surveys and education to assigned members and engages them into programs, completes non-clinical interventions to meet member needs and identifies and refers candidates who require complex interventions to other programs/resources utilizing established criteria and documentation processes
- 25% - Assist with FEP Administrative processes including, but not limited to, retrieving and assigning referrals, completing monthly reconciliation report between documentation system and FEP portal.
- 10% - Completes program participant and provider communication activities as assigned, and documents all interventions in the participant’s record/documentation system in accordance with established policies and procedures.
- 5% - Identifies and reports potential quality of care issues as established and within the guidelines of intradepartmental processes. Complies with policies and procedures. Identifies opportunities and proposes alternatives for improving the Population Management Programs. Prioritizes multiple tasks and assignments on a daily basis, seeks Team Lead guidance as appropriate.
Skills:
- Ability to operate a personal computer (PC), including proficiency in Word, Access, Excel and Outlook and Clinical Databases utilizing a talk and type method of documentation.
- Ability to interact with other departments, as needed, to advise, educate and/or direct members to appropriate services.
- Ability to apply critical thinking skills to daily activities.
- Demonstrates openness, flexibility, problem solving, patience, and tact when dealing with program participants, family and staff.
- Excellent written and oral communication skills.
- Ability to provide focus to Member/Family and redirect as needed.
- Excellent customer services skills and abilities that are demonstrated by prior work experience and references.
- Capable of working independently as well as part of a team.
Knowledge:
- Knowledge of NCQA standards for Population Health Management for health plan accreditation, DMAA standards for disease management and CMSA Standards of Practice for Case Management, Act 68, NCQA, CMS and ERISA.
- Knowledge of managed care principles and emerging health treatment modalities.
Experience:
- Five (5) years’ experience working in an acute care hospital or other appropriate healthcare setting including responsibility for accurate data entry, efficient management of high volumes of phone calls or inquiries and demonstrated independent problem solving using pre-established guidelines and protocols
Education and Certifications:
- High School diploma required. Certified Medical Assistant preferred.
Physical Demands:
Sedentary work involving significant periods of sitting, talking, listening, typing and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.
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