SCOPE OF ROLE

The Care Navigation Representative works provides clinically oriented consumer support services to Bright Health members and providers. As a member of the Care Navigation team, the Care Navigation Representative assists in the identification of in-network care locations to meet the needs of our members and supporting providers and may support the investigation and resolution of other clinical service inquiries referred by Bright’s customer service team.

ROLE RESPONSIBILITIES

The Care Navigation Representative job description is intended to point out major responsibilities within the role, but it is not limited to these items.

• Follow applicable procedures, typically working with other Bright team members, to identify in-network sites of care for Bright members, as requested.
• Field inbound Care Navigation calls from members and/or providers, working to resolve open questions and/or concerns.
• Triage clinical concerns, referring benefit questions back to member services when appropriate.
• Conduct outbound calls to members in alignment with organizational initiatives as defined.
• Fulfill training requirements, as assigned by supervisor.
• Participate in the implementation of new network navigation and consumer service initiatives.
• Manage individual workplan and prioritize time appropriately to meet key deliverables.
• Other duties and responsibilities as assigned

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• High School Diploma or GED required, Bachelor’s Degree in a related field preferred
• Two (2) or more years of experience within a consumer support/customer service function
• One (1) year of healthcare related experience required
• Awareness and experience with HIPAA requirements for healthcare communications preferred
• Prior experience with URAC accreditation preferred

PROFESSIONAL COMPETENCIES

• Approaches challenges calmly and objectively to identify the best solution
• Capable communicator that can interact with others at multiple levels within the organization, customers and providers
• Leads through influence and example
• Strong operational mindset and uses data to draw insights
• Thrives on driving results in a collaborative environment

WORK ENVIRONMENT

The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.