JOB SUMMARY

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The Member Navigator works directly with members who have chronic health issues, gaps in care, or are difficult to engage; guides these members through the health care system and works to overcome non-clinical obstacles that prevent them from receiving the care and treatment they require. Works closely with teams across multiple departments, provider offices, and community resources to foster timely delivery of quality, accessible health care services.

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ESSENTIAL FUNCTIONS OF THE ROLE

\n\nReaches out to and engages members telephonically and other appropriate methods. Establishes a trusting relationship with members, and works with the members to assess the barriers that are preventing them from receiving the care and treatment they require. Serves as member advocate and facilitator in overcoming identified barriers to care. Creates connections between members, health care providers, community resources and case management staff, as needed.\nConducts member screenings and refers to case management if clinical needs are identified.\nMaintains appropriate documentation of member contact, referrals and outcomes. Verifies and updates member demographic information.\nPerforms quality assurance reviews and trend study; initiates process corrections and training requirements, and sets goals for improvements. Conducts regular assessments of the navigation program; identifies weaknesses and works across health plan departments to create and deploy strategies to improve program quality.\nBuilds partnerships with teams across multiple departments, provider offices and community resources to foster timely delivery of quality, accessible health care services.\nContinuously expands knowledge and understanding of health plan services and benefits, provider network, and community resources.\nDevelops scripts, process flows, etc. for member outreach.\n\n

KEY SUCCESS FACTORS

\n\nExperience as a community health advocate and/or navigator.\nNaturally attuned to the people and community being served.\nKnowledgeable about the environment, healthcare system and community resources.\nSkilled in developing and maintaining effective relationships with providers, administrative and professional staff within the health plan and across the system to foster timely delivery of quality, accessible health care services.\nExcellent verbal, written and electronic communication skills required.\nProficient in all Microsoft applications, including Word, Excel, and PowerPoint.\nSkilled in data collection, research and report writing.\nAble to work autonomously with minimum supervision, in a fast paced environment with clear focus on program priorities.\nAble to exercise initiative, judgment, problem solving and recommendation making skills.\nExcellent time management skills with the ability to meet deadlines.\n\n

BENEFITS

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Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

\n\nImmediate eligibility for health and welfare benefits\n401(k) savings plan with dollar-for-dollar match up to 5%\nTuition Reimbursement\nPTO accrual beginning Day 1\n\n

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

\n\n\n\tEDUCATION - Associate's or 2 years of work experience above the minimum qualification\n\tEXPERIENCE - 3 Years of Experience\n