Care Navigator (NH)

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.

Job Summary:

The Care Navigator is a valued non-clinical team member of the Wellsense Health Plan, dedicated to engaging members in care management and ensuring seamless coordination of their healthcare needs. With a focus on resolving issues and providing vital support to the care management team, the Care Navigator collaborates closely with clinical team members, customer care staff, and other internal departments to address member needs effectively.

In this role, the Care Navigator wears many hats on behalf of the member, from ensuring their needs are promptly met to managing essential administrative tasks. The Care Navigator is focused on delivering exceptional support and facilitating smooth communication across various stakeholders. The Care Navigator makes a positive impact on Wellsense Health Plan members' healthcare journeys.

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 Non Emergent Medical Transportation (NEMT) responsible for managing the internal NEMT mailbox, provides initial triage for issues, and escalates as appropriate.
• Acts as a point of contact for assisting member and/or clinical team with inquiries related to Durable Medical Equipment (DME), pharmacy, and Prior Authorization.
• Maintains accurate and timely documentation in the medical management information system in keeping with contractual requirements, internal policy and accreditation standards.
• Partners with department leadership and team members to organize staff assignments, prioritize and triage activities and calls.
• Provide administrative support to Wellsense high risk/high needs, Priority Population Programs and Transitional care management programs.
• Programs Wellsense 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

Supervision Exercised

• N/A

Supervision Received

• Regularly scheduled meetings with Manager/Supervisor of Care Management

Qualifications

Education Required:

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

Education Preferred:

Experience Required:

• Two years of office experience, specifically in either a high-volume customer service call center, data entry office, or health care office administration department

Experience Preferred/Desirable:

• Prior customer service/call center experience, such as 211 the connection for New Hampshire residents to the most up to date resources
• Prior work with low income, Medicare and Medicaid populations preferred
• Prior work with individuals with behavioral health care needs such as a Community Mental Health Centers or Behavioral Health facilities.
• Bilingual

Required Licensure, Certification or Conditions of Employment:

• Pre-employment background check

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
• Ability to effectively collaborate with health care providers and all members of the interdisciplinary team
• 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
• Knowledge of medical terminology strongly preferred

Working Conditions and Physical Effort

• Fast paced environment
• No or very limited exposure to physical risk.
• No or very limited physical effort required
• Regular and reliable attendance is an essential function of the position
• Travel within the plan geographic area required
• Work will be performed at home and or the corporate office work.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees