Job details

Medicare Healthcare Navigator - Flexible Remote

Overview:

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality.

Fallon Health’s NaviCare is a program for people age 65 and older, who live in our service area, and who have MassHealth Standard, and may have Medicare. It combines MassHealth (Medicaid) and Medicare benefits, including prescription drug coverage. At Fallon Health, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique.

Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary of Purpose:

The Care Coordinator or Navigator partners with Fallon Health Care Team staff and other providers to communicate at all times what is occurring with the member and their status. The Care Coordinator or Navigator seeks to establish telephonic and face to face (depending upon product and circumstance) relationships with the member/caregiver(s) and provider partners to better ensure ongoing service provision and care coordination, consistent with the member specific care plan. In order to effectively advocate for member needs, the Care Coordinator or Navigator may make in home or facility visits (depending upon the product and circumstances) with or without other Care Team members to fully understand a member’s care needs.

Responsibilities:

Responsibilities Include But Are Not Limited To:

Coordinating care and community-based services for members of the NaviCare program
Central point of contact for member and providers, facilitating to meet member needs and transitions
Conducting telephonic assessments and may conduct face to face member visits to assess members utilizing TruCare Assessment Tools
Maintaining member records- including but not limited to adhering to CMS regulatory requirements, documentation, outreaching to members to educate and coordinate clinical/preventative screenings
Establishing and developing effective working relationships with community partners such as housing staff, adult day health care staff, assisted living staff, group adult foster and adult foster care staff, rest home staff, long term care facilities and other providers including primary care providers with the goal to facilitate member specific communication, represent Fallon Health in a positive and effective manner, and work to grow membership in the various Fallon Health products as applicable

Qualifications:

Education:

College degree (BA/BS in Health Services or Social Work) preferred

License/Certifications:

Current MA Driver’s License and reliable transportation. No certifications are required.

Other:

Satisfactory Criminal Offender Record Information (CORI) results.

Experience:

2+ years job experience in a managed care company, medical related field, or community social service agency required
Understanding of hospitalization experiences and the impacts and needs after facility discharge required
Proficient in Microsoft Office applications
Knowledge of computer-based phone system preferred

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Fallon Health Glassdoor Company Review

3.7