Manager, Clinical Integration Navigators

Fallon Health•Worcester, MA

About The Position

The manager, clinical integration navigators leads a centralized navigator support function responsible for operational excellence across care coordination and service delivery. This role overseas team performance,develops standardized workflows, and establishes effective intake, triage, and escalation processes particularly for DME, Dental, and PCA services. The manager partners closely with internal stakeholders, providers, vendors, and IT to ensure regulatory compliance, operational efficiency, and consistent high-quality support from members, providers, and care teams.

Requirements

Bachelor’s Degree or equivalent experience (Health Services or Social Work) preferred
Must possess a valid drivers’ license
Must attest to no disqualifiers per Driver Safety Policy
Must possess and provide proof of minimal state required auto insurance
Must have reliable transportation
Three+ years of supervisory/management experience in a healthcare setting, experience leading both clinical and non-clinical staff
Coordinating care as part of an interdisciplinary team for adult populations with chronic conditions, including behavioral health conditions and or substance use disorder
Knowledge of home services (skilled/non-skilled), medical and behavioral health services, and levels of care (acute, rehab, long-term)
Working knowledge of Medicare and Medicaid coverage criteria and requirements experience developing policies, procedures, and operational workflows
Experience leading performance improvement initiatives using objective data (e.g. defining report/query criteria, implementing process changes)
Lean Six Sigma or similar continuous improvement methodology

Responsibilities

Accountable for the end-to-end design, implementation and optimization of program workflows supporting care coordination services
Leads the translation of organizational and department direction into scalable standardized operational models, ensuring navigator support programs are consistently executed across teams and services
Ensures operational readiness prior to the rollout of new or revised support workflows, tools, or vendor relationships, including validation of processes, staff preparedness, documentation, standards and escalation pathways, develops documents and maintains policies, procedures, and standardized workflows to promote consistency regulatory compliance and sustainable performance
Designs and overseas intake, triage, and resolution processes for complex and high volume service requests, including durable medical equipment (DME), dental and personal care attendant (PCA) services
Partners with IT, operations, and internal stakeholders to optimize system functionality, workflow efficiency, and reporting capabilities that support navigator support programs
Ensures effective integration and collaboration across navicare care management teams by defining clear roles, workflows, and operational handoffs
Oversee collaborative relationships with provider groups, including embedded and enhanced partnerships
Represent Navicare program with external partners for care management program
Resolves systemic operational issues affecting providers, vendors or navigator workflows
Establish and maintain vendor escalation pathways, communication standards, and service expectations
Monitor vendor performance and collaborate on workflow improvements for enhanced service delivery
Navigator support operations align with regulatory and contractual requirements
Support audits, reviews, and performance improvement initiatives related to workflows
Ensure consistent documentation practices in quality across the team
Oversee the Support Navigator Supervisor and daily support team operations
Establish performance expectations, monitor productivity, quality, and service outcomes of support team
Provide coaching, performance management and support professional development
Ensure staff training compliance and adherence to workflows and documentation standards
Collaborate with care management, quality, utilization management, provider relations, and operational teams
Serve as subject matter expert for navigator support operations and escalation frameworks
Perform other duties as assigned consistent with the role