Member Care Navigator - Hybrid Role

Elevance Health; Clayton (NC); Hybrid; USD 48,000 - 64,000; Full time

Job summary

Elevance Health in North Carolina seeks a Health Care Coordinator to manage a member's individual service plan and coordinate care across the clinical team. You will perform telephonic or in-person assessments, identify care needs, and arrange services while ensuring cost-effective utilization.

The role requires travel to worksites and compliance with state laws; a BA/BS in a health-related field is preferred and a Community Health Worker cert may be required within one year.

Qualifications

• 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.
• Requires 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.

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 (including, but not limited to, potential for high risk complications) and coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order 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 ensure cost effective and efficient utilization of services.
• Establishes short and long-term goals in collaboration with the member, caregivers, family, natural support, and physicians.
• Identifies members that would benefit from expanded services.
• Travels to worksite and other locations as necessary.

Skills

Care coordination

Assessment calls

Team coordination

Travel required

Education

BA/BS in Health Care

Job description

Elevance Health in North Carolina seeks a Health Care Coordinator to manage a member's individual service plan and coordinate care across the clinical team. You will perform telephonic or in-person assessments, identify care needs, and arrange services while ensuring cost-effective utilization.

The role requires travel to worksites and compliance with state laws; a BA/BS in a health-related field is preferred and a Community Health Worker cert may be required within one year.