Care Management Navigator

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at20daysof paid time offand 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life andDisability
• 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 ofProfessionals.

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.
• Provides administrative support to care coordination staff

Education:
High School Diploma or equivalent required and
Associate's Degree in a healthcare related field preferred

Work Experience:
Minimum of one year of customer service experience required