Job Care Navigator – WellSense Health Plan

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It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Care Navigator is a non-clinical member of the Care Team whose role is to engage members in care management, ensure member’s care is coordinated, issues are resolved and support the Care Management team.

The Care Navigator collaborates with their clinical team members, the Customer Care department and other internal departments to support member needs.

Our Investment in You :

  • Full-time remote work
  • Competitive salaries
  • Excellent benefits

Key Functions / Responsibilities :

  • Uses motivational interviewing skills to engage members into care management via telephonic outreach
  • Provides information to members with the goal of increasing Member knowledge and participation in their own healthcare management including but not limited to information on how to obtain resources;

basic health information; information packets containing health information relative to the Member’s identified condition

  • Advocates for the Member by sharing information with community-based providers to include follow-up on closed loop referrals
  • Answers and triages calls from the department’s toll-free line
  • Triages cases to clinical staff, other departments, contracted vendors and providers as appropriate
  • Manages referrals, performs telephonic screening assessments, arranges wellness visits and provides appointment and preventative care reminders, as needed
  • Coordinates and facilitates access to services, resolves issues or benefit questions, and transfers to the appropriate Care Manager as needed
  • Performs Care Management Case Closure Satisfaction Assessments with Members
  • Acts as the primary point of contact for Coordinated Transportation Solutions (CTS), responsible for managing the internal CTS mailbox, provides initial triage for issues, and escalates as appropriate
  • Partners with department leadership and team members to organize staff assignments, prioritize and triage activities and calls
  • Provide administrative support to Well Sense high risk / high needs and Transitional care management programs
  • Programs member cell phones as needed to support care management team
  • Responsible for preparing department data / reports assigned by Management
  • Provides administrative support for meetings
  • Identifies opportunities for improvement in administrative workflows and processes
  • Performs other associated tasks as assigned by Manager
  • Maintains accurate and timely documentation in the medical management information system CCMS / JIVA in keeping with contractual requirements, internal policy and accreditation standards.

Qualifications : Education :

Education :

Associate’s degree required in health care or a related area or equivalent relevant work experience

Experience :

  • Two years of office experience, specifically in either a high-volume customer service call center, data entry office, or health care office administration department
  • Prior customer service / call center experience preferred
  • Prior work with Medicaid population preferred
  • Bilingual preferred

Competencies, Skills, and Attributes :

  • Strong motivational interviewing skills
  • Ability to engage members
  • Strong oral and written communication skills
  • Detail oriented
  • Ability to work independently but also in a team setting
  • Demonstrated strong organizational and time management skills
  • Demonstrated ability to successfully prioritize, plan, organize and manage multiple tasks in a face-paced environment
  • Intermediate skill level with Microsoft Office products Outlook, Word, Excel
  • Ability to effectively collaborate with health care providers and all members of the interdisciplinary team
  • Knowledge of medical terminology strongly preferred

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans.

Founded 25 years ago, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.

Required Experience