Care Navigator (Remote - Massachusetts)

CareSource; Massachusetts; Hybrid; USD 41,200 - 66,000; Full time

Job summary

CareSource is seeking a Care Navigator responsible for conducting telephonic interactions and supporting administrative functions that enhance member satisfaction. You will engage with providers and members, coordinate services, and ensure timely documentation.

The ideal candidate should have a high school diploma and at least one year of related experience. Skills in customer service, communication, and proficiency in Microsoft Office are essential. This role offers a competitive hourly salary between $41,200 and $66,000.

Qualifications

• 1 year of related experience in a health-related service field required.
• Ability to work in multiple systems, often simultaneously.
• Flexibility to adapt to business needs.

Responsibilities

• Conduct outreach to members and providers to confirm service details.
• Coordinate services to manage scheduling and updates.
• Serve as a support resource for member and provider requests.

Skills

Critical thinking and troubleshooting skills

Strong customer service and problem-solving skills

Clear, concise, and effective oral and written communication

Proficiency in Microsoft Office Suite

Strong time management

Excellent organizational skills

Education

High School or GED

Job description

Job Summary

The Care Navigator is responsible for conducting telephonic interactions, documenting service activities, and supporting administrative functions that enhance member satisfaction. Care Navigators also contribute to core operations including intake, triage, scheduling coordination, provider and member engagement, centralized documentation, and escalations.

Responsibilities

• Conduct outreach to members and providers to confirm service details, coordinate scheduling, address general inquiries, and ensure accurate documentation of care coordination activities.
• Coordinate services by working with providers, community partners, and members/caregivers to manage scheduling, service updates, and administrative changes.
• Serve as a support resource for member and provider requests, escalations, or concerns by coordinating responses and ensuring issues are routed or addressed promptly.
• Collaborate with the care team, providers, and other partners as needed to support member service requests and ensure smooth communication and continuity across care activities.
• Initiate outreach to members, vendors, providers, and/or suppliers to follow up on non‑clinical matters assigned by the Care Team (e.g., authorization status, DME status, appointment scheduling, prescription assistance).
• Assist members with transportation scheduling to medical appointments and booking issues.
• Support targeted member outreach campaigns for events that may broadly impact membership wellness, such as agency closures or catastrophic events.
• Coordinate interpreting and translation services for members, ensuring ADA compliance.
• Obtain documents/forms that allow Care Team to speak with members and/or representatives on the member’s behalf in accordance with HIPAA laws (e.g., Release of Information, Oral Disclosure of Protected Health Information).
• Assist leadership with the development, refinement, and enhancement of programs, initiatives, processes, policies, workflows, and projects.
• Mentor new Care Navigation Specialists during and beyond their orientation period, if needed.
• Maintain accurate documentation of member records in alignment with regulatory standards, ensuring timely distribution to appropriate internal teams or provider partners.
• Follow established standards of practice, internal policies, and procedures to ensure compliance with contractual obligations and applicable regulatory requirements.
• Identify member and provider needs and facilitate referrals to internal teams such as care management or community‑based support programs.
• Perform any other job‑related duties as requested.

Education and Experience

High School or GED required. One (1) year of related experience in a health‑related service field required.

Competencies, Knowledge and Skills

• 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.

Licensure and Certification

None required.

Working Conditions

General office environment; may be required to sit or stand for extended periods of time. Travel is not typically required.

Compensation

Hourly salary range: $41,200.00 - $66,000.00. Compensation is based on a combination of education, training, experience, role scope, and performance. Additional bonuses tied to company and individual performance may be available.

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

Equal Opportunity Statement

CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. CareSource reserves the right to amend this job description at any time.