Fallon Health

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Care Coordinator (Navigator) - Chinese (Mandarin) speaking preferred! - Growing Health care company!

Care Coordinator (Navigator) - Chinese (Mandarin) speaking preferred! - Growing Health care company!

Job ID 
# Positions 
Posted Date 
Care Coordination

More information about this job


About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.


About NaviCare:

Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes.


Position Overview:  

The Navigator helps the primary care provider, nurse case manager, geriatric support services coordinator, long-term care facility liaison and other providers know at all times what is occurring with the Enrollee and their status. Responsibilities include: placing referrals and following up to ensure services are in place as per the individual care plan; coordinating and documenting PCT meetings, facilitating data transfers and ensuring the Centralized Enrollee Record (CER) and Fallon Health Core System is up to date. The Navigator works closely with the Nurse Case Manager. The Navigator refers to the Nurse Case Manager/PCP whenever clinical decision making is required. In order to effectively advocate for Enrollee needs, the Navigator makes in home visits/long term care facility visits with/without the Nurse Case Manager/GSSC to fully understand an Enrollee care needs. 


The Navigator seeks to establish a relationship with the Enrollee/caregiver(s)/facilities to better ensure ongoing service provision and care coordination, consistent with the member specific care plan.




  • Outreaches to all new NaviCare Program Enrollees within designated periods from start date of enrollment via the telephone and/or in person. Introduces self/role and ensures the Enrollee/caregiver/facility is orientated to the NaviCare Program and benefits
  • Gathers data from the Enrollee’s medical record in areas such as preventative health screenings, working with the Enrollee and Primary Care Provider to ensure the Enrollee receives health care according to established guidelines
  • Responds to Enrollee/caregiver/Facility questions or concerns about their health/benefits
  • Makes in home/institutional/office visits as need be to introduce self/role and ensure the Enrollee/caregiver/facility is orientated to the NaviCare Program and benefits
  • Coordinates Enrollee visits to the Primary Care Physician (PCP) and other clinicians as appropriate based upon clinical need and program guidelines, including but not limited to ensuring adequate transportation
  • Follows up with the Enrollee to ensure they were seen by the PCP and other clinician appointments and obtains the clinical summaries from the appointment and scans into the CER per Department process
  • Is a member of the Enrollee’s Primary Care Team (PCT)
  • Coordinates/schedules PCT meetings on a regular basis depending upon Enrollee needs according to Department guidelines
  • Ensures PCT meeting summaries are entered/scanned into the CER per Department process
  • Coordinates and ensures members of the PCT (i.e. Geriatric Support Services Coordinator or Long Term Care Facility Liaison, NaviCare Program Case Manager, NaviCare Program Behavioral Health Clinician and others) are involved and knowledgeable about the Enrollee status based upon Enrollee need and PCP/PCT direction at all times
  • Ensures authorizations for NaviCare Program specific covered services are entered into the CER and the FCHP Core System as appropriate based upon Department processes
  • Ensures the Enrollee’s Individual Plan of Care (IPC) is up to date in conjunction with plans developed by members of the Primary Care Team/Primary Care Physician
  • Ensures the Enrollee is in agreement with their ICP and documents Enrollee approval of such in the CER
  • Ensures the Nurse Case Manager follows up with Enrollees after an emergent/urgent care need and/or care transition such as a hospitalization or skilled nursing facility admission
  • Works with the emergent/urgent/acutecare/skilled nursing facility provider to obtain discharge documentation and ensures information is entered/scanned into the CER per Department process and shared with all members of the PCT
  • If any Enrollee assessment or reassessment is positive for new risk factors, the Navigator in conjunction with the Nurse Case Manager facilitates a PCT meeting, updates the care plan as appropriate, and initiates the development of a support system to avert further deterioration.
  • Responsible for updating and maintaining accuracy of panel access data base lists – processes according to Department guidelines.
  • For those with a panel of Enrollees residing in Long Term Care, obtains MDS forms from the Facilities as per Department processes and ensures the data is integrated into the Centralized Enrollee Record
  • Uses the appropriate FCHP IT application(s) including the CER to document all case activity and facilitate appropriate communication between The PCT Team members
  • Identifies and shares best practices and innovative care management strategies with the team
  • Resolves conflicts among participants in the care planning process
  • Creates contingency plans for each step of the process to anticipate treatment and service complications, while ensuring that the Enrollee attains pre-determined outcomes
  • Supports department colleagues, covering and assuming changes in assignment as assigned by Supervisor/designee
  • Strictly observes HIPPA regulations and the FCHP policies regarding confidentiality of member information
  • Performs other responsibilities as assigned by the Supervisor/designee, including but not limited to covering the NaviCare Enrollee Service ACD lines.




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




Current MA Driver's License




1-3 years job experience in a medical related field or with a healthcare payor company.

Experience in a healthcare payor company a plus.

Experience caring for the geriatric population.

Multi-Lingual desired-Spanish, Vietnamese, Portuguese, Khmer (listed in order of preference)