Exl Service

  • Care Navigator

    Job Location US-FL-Tampa
    ID
    2018-6138
    Type
    Regular Full-Time
  • Overview

    Why join EXL?
    At EXL, were more than just an analytics, operations management, and technology Company. We focus not only on our outstanding Team Members, but on our growing industry as well.
    Headquartered in NYC, EXL has more than 27,000 professionals situated in locations throughout the United States, Europe, Asia, Latin America, and South Africa.

    Our EXL Team Members receive the benefit of:
    Valuable Compensation Package:
    • Competitive Wages
    • Work-Related Expense Reimbursement
    • Annual Discretionary Bonuses
    • Team Member Referral Bonuses

     

    Comprehensive Health & Welfare Benefits:
    • Group Medical, Dental and Vision Benefits
    • Flexible Spending Accounts and Health Savings Accounts
    • Generous Paid Time Off, Sick Days and Holiday Pay
    • Group Life Insurance, LTD and 401k Retirement

     

    Inviting Culture & Team-Oriented Philosophy:
    • Exciting Work Environment
    • Casual Dress Code
    • Monthly Team and Company Events
    • Team Member Appreciation Awards
    • Remote, Home-Based Opportunities
    • Opportunities for Upward Mobility

     

     

    A Care Navigator is a vital contributor of the Care Management team that will support members and providers within various markets. This role requires a strong telephonic communicator who can speak with members/providers to assist and coordinate with follow up or wellness visits, assist members with their care needs by utilizing local resources and locating participating providers. We are looking for someone with initiative who works well within our Care Management team to ensure excellent quality member care coordination with positive outcomes. This position also works closely with our Care Management Programs to ensure members are referred to the most appropriate care management program. This position will be housed out of the Tampa FL Office, and report to the Utilization Management Supervisor, as part of the Care Management team located within our call center environment.

     

    Schedule: Monday through Friday alternating weekly between 9 am - 5:30pm/2:30 pm - 11 pm

    Responsibilities

    Inbound Call Center environment as part of a team approach
    Assist with location of participating providers and/or ancillary services
    Assist with appointment scheduling (follow up and/or Wellness)
    Assist with coding GAPS
    Review members for High Utilization of IP and/or ER Visit for Care Management Programs
    Follow up with Bright Spot Clinics for pre-visit planning
    Promote patient education, self-management support and timely delivery of health care.
    Identify and work with individual and patient populations as required for clinical or medical reasons.
    Outreach to patients/providers via phone
    Communicates patient needs and arranges services with appropriate community resources by market
    Document ongoing status, interventions, patient response and outcomes in accurate, timely manner within designated Care Management System
    Appropriately escalate concerns to an appropriate clinician
    Collects, tracks, and reports data as required
    Use information technology to communicate, manage knowledge, mitigate error, and support decision-making
    Develop working relationship with providers/Bright Spot Clinics
    Demonstrates a commitment to the organization through ongoing participation in team- based client and organizational meetings.
    Builds trusting relationships with internal and external customers,
    Other duties as assigned

    Qualifications

    Knowledge of Medicare Health Care Delivery system
    Knowledge of Medicare Standard Benefit Packages, Part, A, B, C and D
    Knowledge of local, community resources and social services by client location/market
    Independent, highly organized team player
    Able to prioritize work
    Able to work in fast paced environment independently
    Able to handle multiple tasks simultaneously
    Must be able to access, research and extract information from online resources
    Knowledgeable in utilization management
    In depth knowledge and use of various software systems
    Excellent verbal and written communication and presentation skills
    Proficient Computer Skills
    Clinical Judgment Skills
    Excellent Communication Skills
    Experience in Call Center Setting
    Managed Care Organization Experience
    Team Oriented
    Excellent Customer Service Skills

     

     

     

    Education:

    High School Diploma required

    Medical Assistant certification preferred


    Work Experience Requirements:

    2 or more years’ experience in Healthcare Delivery System
    Experience in Managed Care Organization preferred
    Knowledge of Medicare regulations/standards preferred
    Knowledge of utilizing community resources
    Proficient Computer Skills
    Skilled Communicator (member and provider)

     

    EEO Statement

    EEO/Minorities/Females/Vets/Disabilities

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed