This position is primarily responsible for managing the Care Navigator. This position supervises, plans, coordinates, and directs staff performances of administrative and clerical duties in support of members, physicians and other care management team staff. The Care Navigator Supervisor is also responsible for training within the Care Navigator department and preparation of a variety of reports and projects as assigned by their manager. The Care Navigator Supervisor fills in for the Care Navigators in their absence and is an escalation point for customer service questions and concerns. This position will be responsible for ensuring Care Navigators complete duties in compliance with CMS and NCQA Special Needs Program requirements.
- Plans, organizes, directs and controls activities of the Care Navigator.
- Monitors the Care Navigator workload and department coverage.
- Monitors quality in the department and coordinates with Care Navigators on quality initiatives and expectations.
- Resolves member’s inquiries, complaints or concerns regarding interactions with the staff and escalates to managers as appropriate.
- Runs necessary reports for the department to complete their daily responsibilities.
- Ensures effective and efficient customer communication and support.
- Creates clearly defined expectations, procedures, goals and incentives for each individual within the department.
- Provides training support to new and existing Care Navigator staff.
- Supports staffing initiatives by screening, interviewing and selecting new employees for current job vacancies.
- Identifies and resolves problems and inconsistencies within the systems and suggests appropriate corrective procedures.
- Provides a superior member experience by providing exceptional customer service.
- Communicates clearly and effectively both in person and on the phone to a variety of audiences including members, care providers, physicians, pharmacists and other staff.
- Manages outgoing and incoming calls to/from members and physician offices.
- Verifies eligibility.
- Accurately inputs necessary data to keep member’s records up to date.
- Confers with physicians, nurses, and other health personnel to provide complete, current, and accurate documentation.
- Analyzes and review data for completeness and accuracy of documentation according to CMS and NCQA standards.
- Other duties as assigned.
- High School Diploma or GED
- 5 + years of experience in a physician’s office, clinical or hospital setting
- 1 + years of supervisory experience
- Experience related to patient education and / or motivational interviewing skills and self - management goal setting
- Experience working with psychiatric and geriatric patient populations
- Excellent verbal and written skills
- Ability to interact effectively with individuals and with multidisciplinary teams
- Proficient computer skills, including Microsoft Word, Excel, Access and Outlook
- Excellent organizational and prioritization skills
- Knowledge of UM / QM processes and principles
- Knowledge of Health Plan compliance requirements
- Knowledge of CMS Special Needs Programs
- Knowledge of medical terminology
- Strong ability to work effectively with nurses, physicians and other non - clinical and operational staff
- Self - motivated
- Ability to look at challenges as opportunities
- Flexible and adaptable of schedule to attend various meetings and / or promotional events
- Ability to read quickly with excellent comprehension and retention
- Bilingual (English / Spanish) language proficiency
- Medical Assistant Certificate
- 2 + years working with the Medicare Special Needs Population
- Good business acumen, especially as it relates to Medicare and Medicaid
- Undergraduate degree preferred, post graduate degree highly preferred
Physical & Mental Requirements:
- Ability to lift up to 10 pounds
- Ability to push or pull heavy objects using up ton 10 pounds of force
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and /or machinery
- Ability to properly drive and operate a vehicle
- Ability to receive and comprehend instructions verbally and / or in writing
- Ability to use logical reasoning for simple and complex problem solving
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Supervisor Care Navigators, Special Clinical Program, San Antonio, TX, Texas
Please see job description.