SCO Care Navigator - Lawrence - Khmer preferred
$58,240–$62,400 year
On-siteLawrence, Massachusetts, United States or Lowell, Massachusetts, United States
Job Summary
Conduct phone and in-person assessments, screenings, and visits using TruCare to update individualized care plans and remove barriers to care for NaviCare members. Coordinate post-transition outreach, appointment scheduling, and medication support while educating members on benefits, coverage criteria, rights, and appeals. Submit and track authorization requests, resolve coverage issues, and facilitate access to medical, behavioral health, and social services including transportation. Collaborate with the interdisciplinary team, providers, and community partners to ensure continuity during admissions, transitions, and discharges. Document accurately in TruCare, maintain knowledge of CMS/State standards, and mentor staff on workflows as assigned. Requires a valid driver's license, reliable transportation, and experience with diverse populations.
Required Qualifications
- Valid driver's license
- Attest to no disqualifiers per Driver Safety Policy
- Proof of minimal state required auto insurance
- Reliable transportation
- Understanding of hospitalization and post-discharge needs
- Working knowledge of medical terminology, common conditions, and medical record documentation
- Ability to identify triggers requiring RN intervention
- Motivational interviewing experience
- Ability to work effectively with diverse and non-English-speaking populations
- Understanding of social determinants of health
- Proficiency with Microsoft Office (Excel, Outlook, Word)
Desired Qualifications
- College degree (BA/BS in Health Services or Social Work)
- Community Health Worker certification
- Satisfactory Criminal Offender Record Information (CORI) results
- 2+ years' experience in managed care and/or community-based health and human services
- Experience with face-to-face member visits and working with providers/community partners
- Experience working on a multidisciplinary care team within a managed care organization
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