Hybrid Member Care Navigator

Elevance Health; Forest City (NC); Hybrid; USD 42,000 - 60,000; Full time

Job summary

Elevance Health in North Carolina seeks a program coordinator to manage each member's individualized service plan under state law and contract. You will perform telephonic or face-to-face history and needs assessments and coordinate with the clinical team to address care needs.

The role covers non-clinical support for members with chronic illnesses, establishes goals with members and caregivers, and identifies those who would benefit from expanded services; travel to worksites is required.

Qualifications

• Requires BA/BS degree field of study in health care related field; education level may be adjusted based on state law and contract requirements.

Responsibilities

• Responsible for overall management of member's individual service plan within the scope of position, as required by applicable state law and contract.
• Responsible for performing telephonic or face-to-face history and program needs assessments using a tool with pre-defined questions for the identification, evaluation, coordination and management of member's program needs.
• Using tools and pre-defined identification process, identifies members with potential clinical health care needs and coordinates those member's cases with the clinical healthcare management and interdisciplinary team to provide care coordination support.
• The process does not involve clinical judgment.
• Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of services.
• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, and physicians.
• Identifies members that would benefit from expanded services.

Education

BA/BS degree in health care related field

Job description

Elevance Health in North Carolina seeks a program coordinator to manage each member's individualized service plan under state law and contract. You will perform telephonic or face-to-face history and needs assessments and coordinate with the clinical team to address care needs.

The role covers non-clinical support for members with chronic illnesses, establishes goals with members and caregivers, and identifies those who would benefit from expanded services; travel to worksites is required.