Care Management Navigator-PRN

Centra Health•Lynchburg, VA

About The Position

The Care Management Navigator serves as a point of contact within the Care Management Team, helping members access and navigate the healthcare system effectively. The role coordinates variance-related processes, supports members with appointments and accessibility concerns, provides education about coverage and available resources, and advocates for informed decision-making. The Navigator also works with the medical care team to identify members’ needs and prioritize issues requiring follow-up or medical referrals. Other duties may be assigned, and the job description may be modified or updated at any time.

Requirements

Bachelor’s degree in a healthcare-related field.
Three years of experience in managed care, including appeals/grievance, claims, and member support roles.

Responsibilities

Serve as variance coordinator for the Care Management Team.
Coordinate with the variance committee as needed.
Assist with member escalations regarding appointments and accessibility.
Educate members about coverage, healthcare navigation, and resources.
Advocate for members to support informed decision-making.
Guide members through the healthcare system.
Collaborate with Care Management Team members and the broader Centra system as needed.
Work with the TPA for members granted variances to help prevent delays in care and claims errors.
Promote informed decision-making among members.
Assist the medical care team in identifying members and their needs, setting priorities, and identifying problems requiring follow-up or further medical referrals.
Perform other duties as assigned.