Specialty Navigator II

UnitedHealth Group•Norwood, MA

2d•$18 - $32•Onsite

About The Position

Reporting to and working under the general direction of the department Supervisor(s) and Manager, the Specialty Navigator II reviews complex referral requests and evaluates and assigns appropriate specialists for patients. The role works with patients and providers to understand requested services, interviews patients as needed to clarify requests, and partners with Specialty Nurses to ensure safe and appropriate clinical handoffs. The position coordinates care within Atrius Health and Reliant and with external partners. The position is part of the Referral/Float Team and is based at 1177 Providence Hwy. in Norwood, Massachusetts. The schedule is Monday through Friday, with eight-hour shifts between 8:30 a.m. and 5:00 p.m. The office-based schedule is determined upon hire; onsite work may be required at the manager’s discretion, including for training or connectivity issues. The role handles complex, detail-oriented referral work involving patients, clinicians, insurers, vendors, and other internal and external contacts. It provides guidance on referral policies, schedules services, supports referral authorizations and coverage verification, assists with referral-related billing matters, and helps resolve complex patient concerns. The Navigator also supports and trains colleagues, contributes to department problem solving and continuous improvement, and follows privacy and HIPAA requirements when handling protected health information.

Requirements

High school diploma or GED.
At least 1 year of experience in a clinical or healthcare setting.
Intermediate proficiency with Microsoft applications, scheduling software, and electronic medical record systems such as Epic or equivalent.
Ability to provide professional, respectful, service-oriented customer service using active listening and problem-solving skills, and to remain calm in stressful situations.
Ability to make decisions guided by general instructions and practices, interpret situations, and recommend solutions to moderately complex problems.
Ability to analyze varied problems using observation, knowledge, skills, and general precedents.
Ability to follow procedures, prioritize and organize work within general guidelines, and seek assistance with difficult or unpredictable situations.
Ability to communicate moderately complex information in English in varied written formats and comprehend and communicate complex verbal information in English.
Working knowledge of standard concepts, practices, procedures, and policies and the ability to apply them in varied situations.
Ability to collaborate in small teams, contribute ideas, identify issues, and respect team members.
Must follow UnitedHealth Group’s Telecommuter Policy if working as a telecommuter.
Must pass a drug test before beginning employment.

Nice To Haves

Strong problem-solving and complex patient management skills.
Relevant experience in a managed care environment.
Strong understanding of health insurance products and limitations to match patients with available providers.
Bilingual ability.

Responsibilities

Review referral information from clinicians and work queues for relevant details about tests, consultations, procedures, and referral requests.
Verify patient demographics and insurance information, and understand requirements and processes across multiple payers.
Review external referrals for opportunities to convert them to internal referrals and discuss available options with patients.
Redirect patients with managed care products appropriately and coordinate safe clinical handoffs with Specialty Nurses, ensuring necessary information is obtained and relayed.
Promote the Atrius Health System of Care by highlighting internal providers and their expertise.
Place referral orders for primary care providers when appropriate, research visit notes to determine referral intent, and process referrals for follow-up or annual visits that require them.
Schedule patients for tests, consultations, services, and procedures with internal departments, local private offices, and outside vendors or providers.
Respond to calls, faxed requests, and other referral inquiries; communicate with physicians and clinicians to obtain authorizations or address patient issues and missing clinical paperwork.
Research patient billing questions and determine whether they relate to the referral process; assist with referral-related billing or denied-referral matters and direct other billing issues to appropriate staff.
Collaborate with the Practice’s Benefits Coordinator to support cost control, benefit-plan guidelines, and required procedures for non-preferred providers or vendors; coordinate second-opinion requests as needed.
Work with supervisors to provide patients timely responses and detailed answers to complex questions.
De-escalate concerns from upset patients and practices through active listening, clear options, and escalation to supervisors when needed.
Support Navigator team roles and train or teach colleagues as needed.
Participate in problem-solving and continuous-improvement activities focused on department productivity and quality.
Contact appropriate parties, such as the Authorization Services Unit, National Imaging Associates, insurance companies, or other outside agencies, to obtain referral authorizations and verify coverage when needed.
Conduct detailed reviews of specialty referral requests with clinical team members to ensure alignment with organizational referral guidelines.
Serve as a primary point of contact for patients regarding specialty referral policies and provide clear, compassionate guidance.
Manage complex patient interactions related to referral decisions while maintaining clinical and organizational standards.
Access only the minimum necessary protected health information, protect its confidentiality and privacy, and comply with Atrius Health privacy policies and HIPAA guidelines.
Perform other duties as assigned.

Benefits

Paid time off accrued beginning with the first pay period and 8 paid holidays.
Medical plan options and participation in a Health Spending Account or Health Savings Account.
Dental insurance.
Vision insurance.
Life and AD&D insurance.
Short-term disability coverage.
Long-term disability coverage.
401(k) savings plan.
Employee Stock Purchase Plan.
Education reimbursement.
Employee discounts.
Employee Assistance Program.
Employee referral bonus program.
Voluntary benefits, including pet insurance, legal insurance, and long-term care insurance.
Performance rewards and incentive and recognition programs.
Comprehensive benefits package, subject to eligibility requirements.