Remote Member Navigator: Care Coordination & Education

Prairie States Enterprises, Inc.; Sheboygan (WI); Hybrid; USD 42,000 - 56,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

STD/LTD

FSA

Paid time off

Personal days

401k with match

Wellness membership

Job summary

Prairie States Enterprises, Inc. is seeking a FiveStar Member Navigator for a full-time hybrid/remote role based in Wisconsin.

The navigator will support members from initial contact through service completion, directing them to high-value providers within direct contracts and episodes of care, while coordinating internal referrals and preventive care efforts. Ideal candidates bring clinical or care navigation experience, strong communication, and the ability to manage a caseload within a

Qualifications

• Education requirement: LPN or ADN with current licensure or minimum 2 years care navigation experience.
• Experience requirement: 3 years in clinical/hospital setting or 2 years care navigation.
• Strong communication and collaboration with health services teams.
• Ability to manage an independent caseload and maintain organization.

Responsibilities

• Navigate members to high value providers based on needs and contracts.
• Collaborate with FiveStar Navigators and nurses on clinical member needs.
• Document interactions and guidance provided to members.
• Coordinate with clinics, DPCs and contracting entities as needed.
• Lead weekly meetings with vendor partners and internal teams.

Skills

Effective communication

Teamwork

Organizational skills

HIPAA compliance

Customer service

Education

LPN or ADN with licensure

Care navigation experience (2+ yrs)

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Prairie States Enterprises, Inc. is seeking a FiveStar Member Navigator for a full-time hybrid/remote role based in Wisconsin.

The navigator will support members from initial contact through service completion, directing them to high-value providers within direct contracts and episodes of care, while coordinating internal referrals and preventive care efforts. Ideal candidates bring clinical or care navigation experience, strong communication, and the ability to manage a caseload within a