Care Management Navigator

Provides support to the Care Coordinators and other staff in the resolution of member related issues. Communicates with members and their families regarding information about MLTC services. Provides summary reports, analysis and support for care coordination related activities. Participates in non-clinical customer service for members enrolled in the VNS Health Plans MLTC plan in collaboration with Care Coordination department and other healthcare professionals. Works under general supervision.

$20.98 - $26.23 Hourly

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays  
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability   
• Employer-matched retirement saving funds  
• Personal and financial wellness programs   
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care    
• Generous tuition reimbursement for qualifying degrees  
• Opportunities for professional growth and career advancement   
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities    
• Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals.

What You Will Do

• Works with members, providers, and staff to identify and resolve member service and retention related issues. Educates potential members/community representatives on plan features, plan benefits, and program admission requirements.
• Coordinates telephonic intake and responses to both clinical and non-clinical customer service issues. Identifies nature of issue, independently responds to and resolves non-clinical issues and complaints and escalates clinical issues to appropriate department and staff.
• Assists in monitoring member satisfaction through phone calls to verify service, answering questions and providing information. Documents member service issues, identifies trends and recommends potential solutions.
• Maintains expertise in VNS Health Plans MLTC benefits, network and organization structure. Acts as a resource to members to guide them in accessing their benefits.
• Places orders or referrals for services and follows up to ensure services are scheduled and provided. Processes and monitors invoices for payment.
• Serves as a resource for MLTC Care Coordinators and other staff in the resolution of member-related issues.
• Establishes effective customer-focused working relationships with members, physicians and providers of long-term care services.
• Audits system-generated reports, reconciles data, and distributes reports to management for review.
• Participates in interdisciplinary team meetings and provides input on customer service-related activities.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Ensures compliance with the VNS Health Plans OICE policies and procedures as well as all Federal and State regulations.

Licenses and Certifications:

• Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs, required

Education:

• High School Diploma or equivalent, required
• Associate's degree in a healthcare related field, preferred

Work Experience:

• Minimum of one year of customer service experience, required