Network Navigator

Mass General Brigham•Somerville, MA

1d•Remote

About The Position

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. The Network Navigator is responsible for proactively guiding health plan members to appropriate, high-quality, in -network providers to improve access to care, reduce leakage, and enhance member experience. This role serves as a key connection point between members, providers, and internal teams to overcome access barriers, schedule appointments, and ensure timely, coordinated care within the plan’s provider network. The Network Navigator will work with Utilization Management, case management, and provider/facility-based discharge planners to ensure access and guidance to in-network facilities and providers to reduce the administrative burden on members and reduce out-of-network utilization, when appropriate.

Requirements

Bachelor's Degree required; experience can be considered in lieu of a degree
At least 1-2 years of social work, case management, or related field, ideally in a clinical setting, preferred
At least 2-4 years of experience in healthcare navigation, care coordination, member services, or managed care highly preferred
Strong understanding of health plan provider networks, referral and authorization processes, and member benefits and access requirements highly preferred
Strong knowledge of healthcare resources, community services, and patient advocacy.
Excellent communication and interpersonal skills.
Ability to collaborate effectively with healthcare professionals across multiple disciplines and experiences.
Strong organizational and time management skills.
Familiarity with electronic health records and case management software.

Nice To Haves

Experience in a health plan, managed care organization, or population health program
Clinical background (RN, LPN, or allied health professional) strongly preferred
Experience working with Medicaid, Medicare, or dual‑eligible populations
Familiarity with network adequacy, access standards, and compliance requirements

Responsibilities

Proactively assist members in identifying and accessing in-network primary care, specialty care, and ancillary services
Educate members on the benefits of using in-network providers, including cost savings and continuity of care
Support appointment scheduling, follow-ups, and referrals to reduce delays in care
Assist members facing access challenges (e.g., provider availability, geographic barriers, transportation, language needs)
Identify and address out-of-network utilization drivers and work to redirect care to in-network providers when clinically appropriate
Collaborate with utilization management, care management, and provider relations teams to close network gaps
Monitor member interactions to identify high-risk leakage patterns and access barriers
Coordinate with provider offices to confirm network participation, availability, and appointment scheduling
Assist providers with member onboarding, referral workflows, and benefit clarification when needed
Escalate provider access or capacity issues to Network Management or Provider Relations
Explain health plan benefits, referral requirements, and network rules in clear, member-friendly language
Serve as a trusted point of contact to reduce member confusion and frustration
Support new members, high utilizers, and members with complex needs during care transitions
Document member outreach, navigation activities, and outcomes in care management or CRM systems
Track metrics related to access to care, appointment completion, network utilization, and member satisfaction
Identify trends and provide recommendations for network optimization and member engagement strategies
Partner with clinical teams, quality improvement, care management, and customer service to support integrated member care
Support health plan initiatives related to access standards, CAHPS improvement, and regulatory compliance
Participate in interdisciplinary meetings and quality improvement efforts