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 accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.
The Navigator helps the Nurse Case Manager, primary care provider and other providers know at all times what is occurring with the member and their status. Responsibilities include: conducting health risk assessments and identifying Fallon Health Care Management Programs the member may benefit from; educating Fallon Health members about their benefits; helping to ensure that physician office visits are scheduled and attended; placing referrals and following up to ensure services are in place as per the individual care plan and ensuring the member’s case 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 member needs, the Navigator may make in home visits with the Nurse Case Manager to fully understand a member’s care needs.
The Navigator seeks to establish a relationship with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member specific care plan.
Education: College degree (BA/BS in Health Services or Social Work) preferred
License: Current MA Drivers License
Experience: 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 with telephonic and in person interviewing skills required
Experience working with a diverse population, newborn - geriatric.
Bilingual skills, fluency in Spanish preferred