[Hiring] Health Navigator @Capital Blue Cross

Role Description

The Health Navigator collaborates with members, family, healthcare providers, community resources, and other members of the healthcare team to coordinate services and address barriers including access to health care, health literacy, transportation, wellness, and gaps in care. The Health Navigator will guide members to achieve optimal and vibrant health by providing tools, information, and assistance to help understand their healthcare options, take control of their healthcare needs, bridge the current gap between social-economic and medical and behavioral needs, and navigate the otherwise often confusing steps along the path to efficient and effective care.

• Identifying, facilitating, and securing access to needed healthcare, social services benefits, and community resources.
• Assist members with navigating the steps along the path to efficient and effective care.
• Coordinate appointments with and transportation to physicians and non-physician providers to ensure timely and efficient delivery of diagnostic and treatment services when needed.
• Actively monitors incoming calls, conducts outgoing calls, and responds to voice mail requests in a timely manner.
• Identify and assess members’ medical, behavioral, social, emotional, and financial needs.
• Effectively utilize resources of social, economic, behavioral, and support systems to connect at-risk members with appropriate community resources.
• Conduct health education.
• Build relationships with members, their families, and caregivers to support achieving their health care goals.
• Provide emotional support and/or refer to community-based or physician/provider for greater level of psychosocial intervention.
• Complete non-clinical surveys and education to assigned members and engage them into programs.
• Identify and refer candidates who require complex interventions to other programs/resources.
• Identify and report quality of care issues in accordance with established departmental policies and procedures.
• Maintain member confidentiality at all times.
• Document all care navigator activities in the care management documentation system.
• Attend company and departmental meetings and training sessions as required.
• Assist with assigned population processes including retrieving and assigning referrals, completing monthly reconciliation report between documentation system(s).

Qualifications

• Critical thinking and problem-solving skills; ability to handle critical situations.
• Excellent written, oral communication, listening, and organizational skills.
• Ability to operate a personal computer (PC), including proficiency in Microsoft Office Products.
• Able to demonstrate strong customer service skills, including tact and diplomacy.
• Ability to appropriately prioritize workload and assignments.
• Ability to work autonomously and as part of an interdisciplinary team.
• Demonstrates sound judgment that affirms the rights and responsibilities of members, families, health care professionals, and health care organizations.

Requirements

• Knowledgeable on how to navigate all aspects of medical, behavioral, and social systems.
• 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.
• Knowledge of current and emerging medical treatment modalities and best practice guidelines.
• Knowledge of adult learning principles, motivational interviewing, and intrinsic coaching techniques.
• At least three (3) years’ recent/related experience working in health and wellness promotion, inpatient, or other appropriate clinical setting.

Education and Certifications

• Patient Navigation certification preferred or obtained within 1-year of employment.
• Licensed Practical Nurse active license or degree in healthcare related field and 3 years of experience directly related to the duties and responsibilities specified.

Benefits

• Comprehensive benefits package including Medical, Dental & Vision coverage.
• Retirement Plan.
• Generous time off including Paid Time Off, Holidays, and Volunteer time off.
• An Incentive Plan.
• Tuition Reimbursement.