Care Navigator

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POST DATE 9/8/2016
END DATE 10/9/2016

Health Choice Preferred South Jordan, UT

South Jordan, UT
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
High School Diploma or GED


Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment while still being valued for your individual strengths Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

The Care Navigator is responsible for making outreach calls to members, coordinating and completing referrals ordered by Primary Care Physicians, and helping to close gaps in care. This position is located in Davis County.

* Conduct member interactions through multiple channels such as telephone, email, and mobile phone
* Document outreach efforts, and provide daily departmental updates on appointment scheduling and tracking/trending of received responses
* Conduct member Health Risk Assessment (HRA) surveys for new members and/or assist members with HRA form completion
* Refer members to case management if member is in need of ongoing case management services
* Complete documentation in electronic medical records and claims systems
* Assist members in obtaining routine medical care through their assigned Primary Care Physician (PCP), and completes PCP reassignments when necessary
* Identify and communicate any recognized opportunities for further development of Health Choice member information, education, and outreach materials

Serve as a resource for providers and as a liaison for Health Choice members in facilitating access to care and services:
* Enter, record, trend, and document referral requests from PCPs.
* Maintain communication with providers and members regarding the most appropriate specialist to refer to in each case.
* Complete any necessary paperwork and facilitate its processing (i.e., referrals, prior authorization requests, case management referrals, etc.)
* Provide support services to members such as scheduling appointments and work collaboratively with Health Choice Clinical Liaisons
* Assist providers with the processing of prior authorizations and referrals as needed

Focus on maintaining or improving quality outcomes:
* Coordinate with all providers involved in the treatment of members identified as needing assistance with managing chronic medical conditions (HCCs, Gaps, CM Referrals)
* Promote Health Choice initiatives by providing assistance in reaching and maintaining Health Choice performance measures
* Identify new opportunities to encourage members personal responsibility for their health care
* Assist with reports and tracking logs for reporting purposes
* Assist with outreach projects and care improvement programs

Professional Competencies (knowledge, skills, and abilities):

* Intermediate computer skills, medical terminology
* Excellent interpersonal, written, and verbal communication skills
* Ability to excel in a fast-paced, multi-tasking environment
* Effective time management skills
* Effective interpersonal and communication skills

Ability to:
* Use electronic medical record and claims systems
* Problem solve, think analytically, and adapt quickly to change
* Work cooperatively, positively, and collaboratively in an interdisciplinary team
* Work respectively and positively with members and providers
* Multi-task, prioritize work tasks, and adhere to deadlines and identified time frames

High School Diploma or equivalent GED

Working within Medicaid environment, health plan preferred

Job: Business Services/Medical Records
Primary Location: Utah-South Jordan
Organization: Health Choice Preferred
Education Level: Associate's Degree/College Diploma
Employee Status: Full Time Benefit Eligible 36-40 hrs/wk
Work Schedule: Days