DSNP Member Care Navigator

The Health Plan (THP); Wheeling (WV); On-site; USD 35,000 - 45,000; Full time

Job summary

The Health Plan (THP) is seeking a DSNP Member Advocate to coordinate administrative functions within the DSNP Program, including Health Risk Assessments, scheduling care team meetings, and outreach. You will work with Nurse Navigators and Social Workers to coordinate care and ensure access to needed services.

Requirements include a high school diploma, basic computer proficiency, knowledge of medical terminology, and telephonic outreach experience.

Qualifications

• High School Diploma is required.
• Proficiency with Windows and general computer tasks is required.
• Knowledge of medical terminology is required.
• Experience gathering health information via telephonic outreach is required.
• Post-secondary coursework in business or health care is helpful; undergraduate degree preferred.
• Strong speaking and written communication, analytical skills, motivation and initiative, and ability to work independently are desired.
• Proficiency with Word and Excel is desirable.

Responsibilities

• Take incoming calls on a direct or ACD line as per unit and job function.
• Perform outbound outreach, welcome, and gap closure calls to members.
• Conduct Health Risk Assessments on DSNP members telephonically or in person when appropriate.
• Schedule member care team meetings and maintain agendas and minutes.
• Refer members to needed health services and facilitate access to resources.
• Coordinate with Nurse Navigators and Social Workers to arrange care and obtain reports/diags.
• Arrange transportation or personal care services as needed.
• Attend member care team meetings as required.
• Monitor Medicaid eligibility changes and assist members accordingly.
• Coordinate Medicare and Medicaid benefits.
• Use THP platforms/applications (HEART, Case Tracker, Cave) proficiently.
• Maintain monthly monitoring scores for accuracy after year one.

Skills

Medical terminology

Phone outreach

Computer skills

Communication skills

Analytical skills

Independent work

Education

High School Diploma

Post-secondary coursework

Undergraduate degree preferred

Tools

HEART

Case Tracker

Cave

Job description

The Health Plan (THP) is seeking a DSNP Member Advocate to coordinate administrative functions within the DSNP Program, including Health Risk Assessments, scheduling care team meetings, and outreach. You will work with Nurse Navigators and Social Workers to coordinate care and ensure access to needed services.

Requirements include a high school diploma, basic computer proficiency, knowledge of medical terminology, and telephonic outreach experience.