Five-Star Member Navigator - Remote/Hybrid

Prairieontheweb; Sheboygan (WI); Hybrid; USD 60,000 - 76,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

401k with match

Paid Time Off

Job summary

Prairie States Enterprises, Inc. seeks a Five Star Member Navigator to deliver a clinically enhanced member experience from first call to service completion.

The role involves guiding members to high value providers, coordinating internal referrals, and promoting preventive care in collaboration with nurses and FiveStar navigators. The position is full-time with a hybrid remote work arrangement in Sheboygan, WI, with a Monday–Friday schedule and no weekends.

Qualifications

• Education – LPN or ADN with current licensure in good standing, OR minimum of 2 years of care navigation experience.
• Experience – 3 years in a clinical or hospital setting OR 2 years of care navigation.
• Strong communication skills (oral, nonverbal, written).
• Ability to work collaboratively with Health Services team and other PSE departments.
• Ability to manage an independent caseload.
• Strong organizational skills and customer service mindset.
• HIPAA regulations adherence.
• Proficiency in Word, Excel, and Outlook.

Responsibilities

• Member navigation to high value providers based on needs within contracts or bundles.
• Collaborate with nurses on clinical member needs.
• Document interactions and guidance provided to members.
• Coordinate with clinics/DPCs on care navigation needs.
• Interact with contracting entities as needed.
• Plan and coordinate vendor partner meetings for member needs.
• Provide internal referrals to pre-cert, UM, CM, DM and Optimal Health.
• Coordinate with second opinion programs as needed.
• Support care coordination and other duties as assigned.

Skills

Effective communication

Collaboration with health services

Independent caseload management

Organizational skills

Customer service orientation

HIPAA adherence

Proficient in Word/Excel/Outlook

Education

LPN or ADN with current licensure in good standing

2+ years care navigation experience

Tools

Microsoft Outlook

Word

Excel

Job description

Prairie States Enterprises, Inc. seeks a Five Star Member Navigator to deliver a clinically enhanced member experience from first call to service completion.

The role involves guiding members to high value providers, coordinating internal referrals, and promoting preventive care in collaboration with nurses and FiveStar navigators. The position is full-time with a hybrid remote work arrangement in Sheboygan, WI, with a Monday–Friday schedule and no weekends.