Commonwealth Care Alliance's (CCA) Care Navigation Specialist is primarily responsible for providing administrative support to the Care Team and CCA CA/MA/ MI members to ensure proper service provision, care coordination and member engagement. The Care Navigation specialist establishes rapport via telephonic interactions with members, caregivers, and providers in order to effectively meet the member's care coordination needs and support satisfaction with CCA services.
Supervision Exercised: No
What You'll Be Doing
Answer incoming member calls for non-clinical issues and questions with the goal of first call resolution with each interaction
Initiate outreach to members, vendors, providers, and/or suppliers to follow-up on non-clinical matters assigned by the Care Partner (e.g., including authorization status, DME status, and prescription assistance)
MA/MI only : Assist members with DME and supply questions, coordinate with DME and Supply Procurement Unit (DSPU) and any other relevant department(s)
Assist members with authorization questions, coordinate with relevant department(s) within CCA, or contracted IPAs
Assist members with appeals and grievances status, coordinate with Appeals and Grievances department (A&G) and any other relevant department(s)
Assist members with scheduling post-assessment PCP or specialty appointments; follow-up to ensure members attended appointments
Educate members about their benefits and how to access them, coordinating with the Contact Center/Member Services team
Help members schedule transportation to medical and social appointments. Maintain proper documentation in member's chart.
Support engagement and member education activities through outbound call and mail campaigns
Attend morning huddles and team meetings (as required)Additional duties as requested by supervisor
Working Conditions
Standard office conditions. Eligible to hybrid remote work, with time spent in community, member-facing
Must be able to come to the local CCA office in the event CCA phone system is unavailable from remote work location
Must have strong internet signal at remote work location
Must be able to come to the local CCA office for administrative activities and scheduled meetings on a regular basis
May require meetings across the state of (MA / CA / MI )
Education Required
What We're Looking For:
Associate degree or a minimum of 2+ years of applicable experience
Education Desired
Bachelor's degree preferred
Experience Required
2+ years office/administration
Experience Desired
Experience working in a health plan, medical group, health-related facility or medical/DME supplier a plus
Knowledge, Skills & Abilities Required
Excellent 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
Knowledge, Skills & Abilities Desired
Knowledge of medical terminology
Language(s) Required
English
Language(s) Desired
Spanish/Vietnamese preferred
Seniority level
Entry level
Employment type
Full-time
Job function
Other, Information Technology, and Management
Industries
Hospitals and Health Care
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