Senior Care Navigator

Pomelo Care

6d•$55,000 - $65,000•Remote

About The Position

Pomelo Care is the national leader in evidence-based healthcare for women and children. We deliver personalized, high-quality clinical interventions from reproductive care and pregnancy, infant care and pediatrics, to hormonal health through perimenopause and menopause, with long-term preventive care and condition management. Our model delivers 24/7 multispecialty care to address the medical, behavioral, and social factors that most significantly impact outcomes for women and children. We partner with payers, employers, and providers to expand access to quality healthcare across the system. Key responsibilities of the role Your North Star: You are the trusted first point of contact for our members. Through every interaction, you deliver clinically accurate, empathetic, and efficient support, ensuring members feel guided, heard, and cared for throughout their journey with Pomelo.You will manage the lifecycle of patient communication and navigation, ensuring no detail is overlooked as our members move through their care journey. Reporting to the Clinical Director, New Ventures, your key responsibilities will include:

Requirements

3+ years of experience in high-touch, patient-facing environments.
Proficient in Zendesk (or similar ticketing tools) and Athena (or comparable EHR systems)
Exceptional written and verbal communication skills, with the ability to translate complex healthcare information into clear, empathetic guidance.
Proven judgment in handling sensitive issues, escalations, and time-sensitive care needs.
Organized, detail-oriented, and energized by managing multiple workflows in a fast-paced environment

Responsibilities

Member Communication: Act as the initial human touchpoint for patients, managing a high volume of inbound & outbound messages via email and chat. Topics may include scheduling, billing, insurance coverage, prescription logistics, and general care navigation (e.g., next steps in care).
Clinical & Operational Support: Coordinate essential care logistics, including verifying medical and prescription eligibility, assisting with specialist referrals, and initiating prior authorizations.
Issue Resolution: As necessary, triage & properly escalate member concerns using established protocols (e.g., complex billing questions to Revenue Cycle team, medical questions to Clinical team).
System Management: Maintain documentation within Zendesk and our Electronic Health Record (EHR) to ensure a source of truth across teams.
Continuous Improvement: Partner cross-functionally to identify friction points in the patient experience. Propose and implement improvements to workflows, tools, and member-facing processes.