Care Navigator (Remote - Massachusetts)

Commonwealth Care Alliance (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care, which yields improved quality outcomes and lower costs of care.

Job Summary:

The Care Navigator is responsible for conducting telephonic interactions, documenting service activities, and supporting administrative functions that enhance member satisfaction. Care Navigators also contribute to core operations including intake, triage, scheduling coordination, provider and member engagement, centralized documentation, and escalations.

Essential Functions:

• Conducts outreach to members and providers to confirm service details, coordinate scheduling, address general inquiries, and ensure accurate documentation of care coordination activities.
• Coordinate services by working with providers, community partners, and member/ caregivers to manage scheduling, service updates, and administrative changes, as needed
• Serves as a support resource for member and provider requests, escalations, or concerns by coordinating responses and ensuring issues are routed or addressed promptly
• Collaborates with the care team, providers, and other partners as needed to support member service requests and ensure smooth communication and continuity across care activities
• Initiate outreach to members, vendors, providers, and/or vendors/suppliers to follow up on non-clinical matters assigned by the Care Team (e.g., including authorization status, DME status, appointment scheduling and prescription assistance)
• Provide administrative support as assigned
• Assist members and the Care Team with solving health plan related concerns, i.e. claims follow up or prior auth status, etc.
• Help members schedule transportation to medical appointments; assist members with booking issues
• Support targeted member outreach campaigns when there is an event that has the potential to broadly impact our membership's wellness, such as agency closures, hazardous/catastrophic events (e.g., power outages, fires, inundations)
• Coordinates interpreting and translation supporting services for the member (including ADA compliance)
• Obtain documents/forms that allow Care Team to speak with members and/or representatives on the member's behalf in accordance with HIPAA laws - e.g., Release of Information (ROI), Oral Disclosure of Protected Health Information
• Assist leadership with the development, refinement and enhancement of programs, initiatives, processes, policies, workflows, and projects
• Mentor for new Care Navigation Specialist - during and beyond their orientation period, if needed
• Maintain accurate documentation and maintenance of member records and alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners as needed
• Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements
• Identify member and provider needs and facilitates referrals to appropriate internal teams such as care management or community-based support programs
• Performs any other job related duties as requested.

Education and Experience:

• High School or GED required
• One (1) year of related experience in a health-related service field required

Competencies, Knowledge and Skills:

• Critical thinking and troubleshooting skills
• Strong customer service and problem-solving skills
• Ability to work in multiple systems, often simultaneously
• Clear, concise, and effective oral and written communication
• Strong time management and demonstrated ability to work independently
• Flexibility to adapt to business needs
• Motivated team player
• Excellent organizational skills
• High attention to detail and accuracy
• Basic arithmetic skills required
• Proficiency in Microsoft Office Suite

Licensure and Certification:

• None required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:
$41,200.00 - $66,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Hourly

Competencies:
- Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.