Job Details

Job id : 6387-3552

Essential Job Responsibilities:

• Provides care navigation services to insured employees and their family members:
  • Completes an initial assessment of current and past health history (physical, mental and psychosocial health) for each insured individual
  • Determine member health risk
  • Develops a plan of care to lessen and avoid worsening health risk
  • Determines potential future needs and develops a plan to address those needs
  • Receives telephone calls or other inquiries from the employee or family, evaluates the current problem and develops a plan of care accordingly
  • Collaborates with third party administrator (TPA) and other external service providers
  • Assists with accessing appropriate level of care
  • Follows up post access to care to evaluate outcomes
  • Provides oversight of chronic medical conditions
  • Researches best practice, high quality care
  • Investigates costs associated with all aspects of care (procedures, labs, medications, surgeries, etc.)
  • Coordinates referrals as needed
  • Researches information on health concerns
  • Advocates for the most appropriate care at the most appropriate time
  • Empowers members through information and support to make informed decisions
  • Communicate with members to promote participation in the development and execution of the plan of care.
• Provides education to facilitate understanding of medical condition and treatment plan developed by medical team (primary care provider, specialist, etc.)
• Guides members through their health care journey, simplifying the labyrinth of health care while being a liaison with; providers, insurance companies, health systems and supplier of health care to maximize cost, quality and satisfaction
• Functions as an advocate and maintains confidentiality. Educate the member, the family, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, case management, etc., so that timely and informed decisions can be made.