FHW Care Navigator

Fallon Community Health Plan, Inc.; Buffalo (NY); On-site; USD 26,000 - 37,000; Full time

Job summary

Fallon Health Weinberg is seeking a Navigator to advocate for Participants and caregivers, coordinating in-home services within the care plan. You will work with the interdisciplinary team to ensure timely authorizations and effective service delivery.

Under the Clinical Nurse Manager, you will collaborate with Home Care Coordinators and other staff to complete assigned tasks, while complying with HIPAA and organizational policies. CPR certification or willingness to obtain is required.

Qualifications

• High School Diploma is required.
• CPR certification or willingness to obtain within 60 days of hire.
• Access to reliable transportation.

Responsibilities

• Outreaches to Participants via telephone and in person following state and organizational guidelines.
• Advocates for Participants and coordinates care plan services.
• Responds to questions from Participants, caregivers or facilities regarding authorized in-home services.
• Coordinates and participates in care transitions and authorizations within the care team.

Skills

Telephonic interviewing

In-person interviewing

Transportation to meetings

Customer service

Education

High School Diploma

Job description

Overview

About us:

Fallon Health Weinberg is a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg offers a Program of All Inclusive Care for the Elderly (PACE) to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara.

Fallon Health is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality. Weinberg Campus has been providing needed services to the elderly for more than 100 years, through both community-based programs and nursing facility care. It is a renowned geriatric education and training institution offering the widest range of housing and care options available on one campus.

At Fallon Health Weinberg, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique.

Brief summary of purpose:

The primary role of the Navigator is to advocate for the Participants and/or caregivers. The Navigator assists and works closely with the Home Care Coordinator Nurse acting as the community liaison ensuring satisfaction of the provisional authorized services developed via the plan of care. Responsibilities include managing referrals/authorizations and coordination of services of the plan of care.

Under the direction of the Clinical Nurse Manager, the Navigator assures timely completion of assigned work in conformance with established departmental policies and procedures. Able to demonstrate independent action. The Navigator presents a clear definition of problem(s) when reviewing with the inter-disciplinary team, clinical staff and other members of Fallon Health Weinberg. ****

Responsibilities

Primary Job Responsibilities

• Outreaches to all Fallon HealthWeinberg Participants via the telephoneand/or in person as per state and organization recommendations
• Ensure care plan provisional services are being met and satisfied
• Acts as Participant advocate
• Responds to Participant/caregiver/Facility questions or concerns regarding authorized in-home services.
• Makes in home/institutional/office visits as need be to introduce self/role and ensure the Participant/caregiver/facility is orientated to the Program and benefits
• Coordinates and ensures members of the IDT (Clinical Nurse Manager, Home Care Coordinator, and others) are involved and knowledgeable about the Participant status based upon Enrollee always need and PCP/PCT direction
• Ensures authorizations for specific covered services are entered into the EHR as appropriate based upon authorized services
• Ensures the Home Care Coordinator follows up with Participant after an emergent/urgent care need and/or care transition such as a hospitalization or skilled nursing facility admission
• Identifies and shares best practices and innovative care management strategies with the team
• Supports department colleagues, covering and assuming changes in assignment as assigned by
• Supervisor/designee
• Strictly observes HIPPA regulations and the FHW policies regarding confidentiality of member information
• Performs other responsibilities as assigned by the Clinical Nurse Manger or designee

Qualifications

Education

• High School Diploma.

License/Certifications

• Access to reliable transportation.
• CPR certification, or willingness to be certified within 60 days of hire, is essential

Experience

• Atleast one year caring for the frail or elderly population.
• Home care or personal care experience preffered.
• Telephonic/ In-person interviewing skills preferred.
• Ability to transport self to/from meetings with Participants and/or vendor agencies in/around the program services area

Pay Range Disclosure

In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $ 23.00 per hour which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Location

US-NY-Buffalo

Posted Date

5 days ago (8/14/2026 10:38 AM)

Job ID

8453

# Positions

1

Category

Administrative Support Workers