Care Navigator

Healthcare Without Rival

Premise Health is the world's leading direct healthcare provider and one of the largest digital providers in the country, serving over 11 million eligible lives across more than 2,500 of the largest commercial and municipal employers in the U.S. Premise partners with its clients to offer fully connected care - in-person and in the digital environment. It operates more than 800 onsite and nearsite wellness centers in 45 states and Guam, delivering care through the Digital Wellness Center and onsite, nearsite, mobile, and event solutions.

Premise delivers value by simplifying complexity and breaking down barriers to give diverse member populations access to convenient, integrated, high-quality care. We offer more than 30 products, delivering the breadth and depth of care required to serve organizations' total populations. The result is healthcare that meets the needs of members and their families, helping them live healthier while lowering costs for organizations.

Premise offers a wide range of dynamic, purpose-driven career opportunities. We are currently looking for a Part-time Care Navigator to join our team in Cambridge, MA.

PURPOSE OF THE POSITION

As a component of Premise Health's Connected Care+ family of products, the Care Navigator helps members and their families traverse a complex healthcare system by providing concierge support to those individuals needing access to high-value specialty care in their communities and ensuring they never have to navigate their healthcare needs alone. Premise Care Navigators serve as patient advocates, simplifying the healthcare journey by sending and reconciling health records, identifying high-value specialists, scheduling appointments, and answering questions. Care Navigators are there for members before, during, and after care to create an exceptional experience.

ESSENTIAL JOB FUNCTIONS

• Works with the member, primary care provider, and other members of the care team to identify and prioritize member's health care needs

• Develops understanding of and leverages Epic's referral and scheduling capabilities and other available tools

• Documents all encounters and follow up plans in Epic

• Develops understanding of where member populations live and work, as well as high-value providers and facilities in key geographies

• Proactively builds relationships with community specialists, alongside other health center team members, to educate them on Premise Health and our expectations, and facilitates streamlined referral access and information sharing

• Works in collaboration with Premise Health Primary Care team members and providers in the community including but not limited to: specialty medical services, behavioral health services, disease care management specialists, social workers, and community-based organizations to help the member maintain bidirectional communication and achieve optimal health outcomes.

• Regularly interacts with Premise providers to understand member referral needs

• Navigates client networks and providers and interprets information to members and their families

• Coordinates information flow of benefits between dental, medical and other healthcare providers within the medical community

• Fosters communications and coordinates benefits with insurance companies with the goal of creating a smooth patient centered experience

• Interacts with members via multiple modalities (phone, email, portal message , etc.) to identify appropriate referral target(s)

• Works with community specialists and members to schedule appointments and ensure bi-directional medical records transfer

• Follows up with member post-specialist visit, ensure member and specialist notes return to Premise, and coordinate ongoing care needs as appropriate

• Remains in close coordination with Connected Care+ product team to leverage new tools and processes as the strategy evolves

• Adheres to timeframes and quality standards regarding completion of member assessments, reassessments, care plans, and documentation (including case notes, updates, consents, etc.

• Manages, prioritizes, and completes multiple referrals simultaneously, expediting urgent referrals as appropriate

• Maintains knowledge of available and appropriate client services and benefits in order to provide advocacy and guidance to members and their families.

• Maintains positive and productive personal presentation with internal and external contacts, ensuring all engagements with staff/coworkers, members, and community partners are professional, courteous, and respectful

• Is familiar with the Premise Health policies and procedures to assure quality assurance and quality improvement are properly implemented as needed

• Partner with onsite health center staff to promote wellness center programs or represent the health center in scheduled or ad hoc employer meetings regarding health and wellness events or strategic initiatives

• All other duties as assigned.

BASIC QUALIFICATIONS

Education:

• High School diploma/GED

Experience:

• 3+ years working in corporate wellness/health promotion or with health system logistics/scheduling

• Epic experience preferred

• Referral experience preferred

• Knowledge and Skills:

• Ability to handle sensitive information confidentially

• Ability to closely adhere to policies, practices, and procedures

• Ability to convey information and ideas effectively both verbally and in writing

• Be able to work in and create a positive attitude environment, manage caseload, complete task/duties and address conflicts as they arise

• Communicate effectively with supervisory personnel in a cooperative and supportive manner

• Be able to tolerate the ambiguity during transition time and take on other assignment as needed

• Excellent problem-solving skills and ability to build positive relationships

• Excellent verbal and written communication skills in a customer service environment

• Excellent time management, organization, research, analytical, negotiation and interpersonal skills

• Knowledge of prior authorization processes and how to execute a prior authorization

Work-life balance is at the foundation of how decisions are made and where Premise is headed. We can only help people get, stay, and be well if we do the same for ourselves. In addition to competitive pay, Premise offers our Part-time Team members life insurance, a 401(k) program, paid holidays and vacation time, a company-sponsored wellness program, and much more our talent acquisition team will be happy to share with you.

Premise Health is an equal opportunity employer; we value inclusion, and we do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.