Care Navigator - Massachusetts at CareSource in Remote

Summary: CareSource is a healthcare organization dedicated to enhancing member satisfaction. The Care Navigator is responsible for conducting telephonic interactions, documenting service activities, and supporting administrative functions to facilitate member care and coordination. Responsibilities: - 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 Required Qualifications: - High School or GED required - One (1) year of related experience in a health-related service field required - 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 Required Skills: Microsoft Office Suite, Basic arithmetic, Health-related service experience, Customer service Benefits: You may qualify for a bonus tied to company and individual performance., Substantial and comprehensive total rewards package.