Health Navigator

About the Role

Are you passionate about making a difference in healthcare? We’re looking for a Health Navigator to join our dynamic team. As a Health Navigator, you’ll be guiding members through their healthcare journey and making a positive impact on their lives.

Primary Focus Areas:

• Health Risk Improvement: Ensuring members receive the right care at the right time and place.
• Readmission Prevention: Providing needed support to keep members healthy and out of the hospital.
• Wellness Support: Encouraging wellness care, appointment assistance and resources aimed to impact healthy outcomes.
• Benefits Awareness: Educating members about their coverage in an effort to maximize appropriate use of their benefits.

Ideal Candidate Profile:

Preferred candidates will have experience in medical front office operations and case management. Multilingual skills are also highly valued. Internal candidates with a performance review rating of 3.7 or higher are highly preferred.

Work Schedule:

The hours for this position are flexible with options of either 9:00 AM - 6:00 PM EST, 9:30 AM - 6:30 PM EST, or 10:00 AM - 7:00 PM EST. The late shift (from 10:00 AM – 7:00 PM EST) is also rotated throughout the year in one-week increments.

Job Responsibilities:

• Conducting educational telephone calls advising members of available benefits, services, and programs; completes health needs assessment, and refers members to population health management programs as appropriate.
• Reaching out to members with identified gaps in care; encouraging and motivating them to become compliant; offering assistance in locating providers and appointment scheduling.
• Managing system work queues; screening identified members for eligibility, prior case activities, recent claims, customer service inquiries, and authorization history; assigning members to a clinical team for call outreach and intervention.
• Facilitating research and analysis of inquiries and/or complaints related to processes and designations, member lost incentives, and other program-related inquiries.
• Work overtime as needed.
• Various immunizations and/or associated medical tests may be required for this position.
• This job requires a digital literacy assessment.

Job Qualifications:

Education:

• Associate's Degree in education, communication, or a health-related field, or equivalent work experience.

Experience:

• 2 years of experience in a customer service support role is required.

Skills/Certifications:

• Ability to work independently with minimal supervision or function in a team environment, sharing responsibility, roles, and accountability.
• Proficient interpersonal and organizational skills.
• Independent, sound decision-making, and problem-solving skills.
• Must be able to work in an independent and creative manner.
• Self-motivated and able to manage multiple tasks and set priorities.
• Effective time management skills.
• Excellent oral and written communication skills.
• Strong interpersonal and organizational skills.
• Knowledge of medical terminology.

About the Company:

Company: BCBST BlueCross BlueShield of Tennessee, Inc.

Worker Type: Employee

Number of Openings Available: 1

Equal Opportunity Employer Statement:

BCBST will recruit, hire, train, and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices.

Applicant Submission Policy:

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet, or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Key skills/competency

• Health Navigator
• Healthcare
• Member Support
• Case Management
• Customer Service
• Communication Skills
• Problem-Solving
• Medical Terminology
• Wellness Programs
• Benefits Awareness