POSITION DESCRIPTION

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve YOUR LIFE'S BEST WORK. (SM)

The primary responsibility of the Care Navigator is to identify, track, monitor, and coordinate the care of members enrolled in Specialized Clinical Programs. As a Care Navigator, you will act as a resource and advocate for members and their families to ensure an optimal level of health. This position is responsible for communication to members, physicians and other care management team serving as a liaison with external departments to ensure optimal customer service.

PRIMARY RESPONSIBILITIES

• Establishes a trusting relationship with identified members, caregivers, clinic staff and physicians.
• Keeps member actively engaged with their primary care physician and assists member with any scheduling medical appointments/transportation
• Partners with the members care team (community, providers, internal staff)
• Serves as primary point of contact for internal and external stakeholders
• Provides guidance and inquires if members need help with any specific barriers to healthcare through telephonic outreach to assist member's compliance with their care plans
• Identifies health plan resources or local community resources to provide solutions for the member
• Engages patient, family, and caregivers to assure that a well-coordinated treatment plan is established
• Creates referrals to outside source(s) to assist with member's self-management goals
• Supports the member to ensure pick-up and adherence of their medications
• Proactively engages the member to manage their care
• Liaisons with providers and facilities telephonically, to assist in problem solving regarding member needs
• Communications with internal staff, member/caregiver and community providers must be accurate and timely
• Member outreach using compassionate customer service with the goal to inform them of care gaps and facilitate the closing of those gaps
• Documents all member interactions in a concise manner that is compliant with documentation requirements for Model of Care and Center for Medicare and Medicaid Services (CMS) regulations
• Conducts in-bound and out-bound calls including, but not limited to: patient scheduling, surveys/screenings, census management and distribution of materials to appropriate clinical personnel or members
• Provides clerical and/or administrative support to clinical staff and managers
• Enters timely and accurate data into the electronic medical record to communicate member needs and ensure complete documentation of member visits and phone calls
• Performs all duties for internal and external customers in a professional and responsible manner
• Adheres to organizational and departmental policies and procedures
• Performs all other related duties as assigned

This position requires answering calls, data entry and working with nurses 1:1 to provide end to end care. This position requires working weekly various shift hours including evenings and rotating/required weekends. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• High School Diploma or GED
• 2+ years of experience in a physician's office, clinical or hospital setting
• Experience working with psychiatric and geriatric patient populations
• Excellent verbal and written skills
• Ability to interact productively with individuals and with multidisciplinary teams
• Excellent organizational and prioritization skills
• Knowledge of medical terminology
• Knowledge of Health Plan compliance requirements
• Knowledge of and experience with medical coding
• Proficient computer skills, including Microsoft Word, Excel, Access and Outlook

PREFERRED QUALIFICATIONS:

• Medical Assistant Certificate
• 5+ years of experience in a physician's office, clinical or hospital setting
• 1+ YEAR WORKING WITH SPECIAL NEEDS POPULATION
• Bilingual in English and Spanish language proficiency
• Good business acumen, especially as it relates to Medicare and Medicaid
• Undergraduate degree preferred, post graduate degree highly preferred
• Experience working with psychiatric and geriatric patient populations
• Knowledge of UM/QM processes and principles
• Knowledge of general IPA operations
• Strong ability to work effectively with nurses, physicians and other clinical and operational staff, both written and verbally
• Self-motivated with strong organizational skills
• Ability to look at challenges as opportunities
• Flexible and adaptable of schedule to attend various meetings and/or promotional events
• Ability to read quickly with excellent comprehension and retention

PHYSICAL & MENTAL REQUIREMENTS:

• Ability to lift up to 10 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.