Member Care Navigator

Elevance Health; Durham (NC); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Elevance Health is seeking a Care Coordination Specialist to manage member service plans, perform assessments, and coordinate with clinical teams to ensure efficient, quality care.

The role emphasizes non-clinical support, collaboration with families and physicians, and travel to worksites within Elevance Health's hybrid model. A BA/BS and 1 year of related experience are required; Community Health Worker certification may be required within one year.

Qualifications

• Requires BA/BS degree and a minimum of 1 year of experience working directly with people related to the specific program population or other related community based organizations; or any combination of education and experience which would provide an equivalent background.
• BA/BS degree field of study in health care related field preferred. Specific education and years and type of experience may be required based upon state law and contract requirements.
• Travels to worksite and other locations as necessary.
• For MMP, requires Community Health Worker certification to be obtained within one year of employment.

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.
• Uses tools and pre-defined identification process to identify 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

Community Health Worker certification (within 1 year)

Job description

Elevance Health is seeking a Care Coordination Specialist to manage member service plans, perform assessments, and coordinate with clinical teams to ensure efficient, quality care.

The role emphasizes non-clinical support, collaboration with families and physicians, and travel to worksites within Elevance Health's hybrid model. A BA/BS and 1 year of related experience are required; Community Health Worker certification may be required within one year.