Job Details
Clinical - Care Navigator
2026-03-18 Mindlance all cities,AKPosition Purpose:
Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.
Education/Experience:
Requires a Bachelor's degree and 2 - 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
License/Certification:
Current state's clinical license preferredEvaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome
Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care
Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner
May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
May perform on-site visits to assess member's needs and collaborate with providers or resources, as appropriate
May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits
Other duties or responsibilities as assigned by people leader to meet the member and/or business needs
Performs other duties as assigned
Complies with all policies and standards
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Story Behind the Need
- What is the purpose of this team?
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
Call Center
Would be working with MSC Department and assisting in taking calls for our STAR+PLUS member.
Team is to cover and answer calls that come in through call center.
This is to cover the SCs who are out in LOA, FMLA and the openings we have open.
Self-starters, eager to learn, great customer service
Each day, they will interact with different members, learning from them and assisting with their individual needs Typical Day in the Role
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
-Day to Day responsibilities - Inbound call center, assist and educate Medicaid members on benefits and Services such as PCP Changes, ID Cards and Coordinate transportation and other services.
Candidate Requirements Education/Certification Required: HS Diplom Preferred: BUT NOT Required: BA in Social Work or Healthcare Mgmt, LVN, CNA, CMA, RT, Pharmacy Tech Licensure Required: Preferred: Years of experience required: Over 5 years of experience working directly with the ABD (Aged, Blind, and Disabled) population in call center environments, Medicaid programs, and Managed Care Organizations (MCOs). Skilled in supporting individuals with disabilities and vulnerable populations managing chronic or complex health conditions. Demonstrated expertise in providing care coordination for children, young adults, and other high-need groups within the past three of the last five years.
Must haves: good attendance, call center background; worked with MCO insurance
Nice to haves: background in Service Coordination, and call center experience.
Disqualifiers: no call center experience
dditional qualities to look for: Software Skills: Will be using various software on the job: Microsoft Office Suite, Avaya, Zoom, Skype
- Top 3 must-have hard skills stack-ranked by importance
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
Type of Interviews:
Teams, phone, etc. Required Testing or Assessment (by Vendor): Typing test, basic computers skills test, etc. Next Steps
- Do you have any upcoming PTO?
- Colleagues to cc/delegate
- (Department of Defense) Will this role operate, support, or utilize DOD data, systems, and/or infrastructure, requiring a National Agency Check with Law and Credit Checks (NACLC)? (Vendors: If yes, NACLC check is required).
- Does this position require a Driver's License to complete the necessary job functions for this role (E.g. Driving to member visits, hospital or provider facilities, sales)? (Vendors: If yes, MVR check is required).
- Does this position require a clinical license or a certification to do the job (including but not limited to RN, Licensed Clinical Social Worker, Medical Doctor, Certified Professional Coder)? Check the job profile for the requisition if you are not clear on the requirements. Note: Requirements in the job profile cannot be changed for individual requisitions. (Vendors: If yes, Clinical Licensure check is required).