Fallon Health
Navigator, Senior Care Options - Worcester/Milford - Spanish Required
Fallon Health, Milford, Massachusetts, us, 01757
Navigator, Senior Care Options – Worcester/Milford – Spanish Required
Join Fallon Health as a Navigator in our Senior Care Options team in Worcester or Milford. We are looking for a bilingual Spanish speaker with strong care coordination and customer service skills.
About Us Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high‑quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self‑expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio‑economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government‑sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All‑Inclusive Care for the Elderly)—in the region. Learn more at fallonhealth.org.
Overview The Navigator is an integral part of an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members. The Navigator partners with Fallon Health Care Team staff and other providers to always communicate what is occurring with the member and their status. The Navigator establishes telephonic and face‑to‑face relationships with the member/caregiver(s) and provider partners to better ensure ongoing service provision and care coordination, consistent with the member‑specific care plan. The Navigator may make in‑home or facility visits, as appropriate, to fully understand a member’s care needs.
Responsibilities
Utilize an ACD line to support the department and handle incoming/outgoing calls with the goal of first‑call resolution.
Conduct telephonic and, when necessary, face‑to‑face member visits to assess members using TruCare Assessment Tools.
Establish and develop effective working relationships with community partners (housing staff, adult day health care staff, assisted living staff, groups for adult foster care, rest home staff, long‑term care facilities, primary care providers) to facilitate member communication, represent Fallon Health positively, and grow membership in applicable products.
Educate members and PRAs about their product benefits and how to access them, often coordinating access.
Help members schedule and attend physician office visits.
Place referrals and follow up to ensure services are in place per the individual care plan, and develop care plans with the Care Team; send member‑specific care plans per process.
Perform care coordination, adhering to contact and duration frequencies, documenting all activities in TruCare with correct assessment and note type following Clinical Integration Documentation Policy.
Contact members to resolve gaps in care (e.g., PCP assignment, verification, preventive screenings, vaccination reminders).
Assist members in obtaining access to care, arranging appointments, and following up to ensure attendance, identifying barriers and enabling attendance.
Facilitate transportation for medical, behavioral health, and social appointments by educating members and, where required, completing the MassHealth PT‑1 process.
Educate members and help obtain community benefits (food via EBT, fuel assistance, WIC).
Screen members for social determinants of health (SDOH) and refer to Clinical Team members and partners for intervention based on criteria.
For maternity members, facilitate delivery of items from the “Oh Baby” program and coordinate after‑care needs with Nurse Case Managers.
Refer to the Nurse Case Manager or PCP when clinical decision‑making is required.
Qualifications HS Diploma/GED required. College degree (BA/BS in Health Services or Social Work) preferred.
2+ years in a managed care company, medical‑related field, or community social service agency.
Understanding of hospitalization experiences and post‑discharge needs.
Knowledgeable about medical terminology and common disease processes.
Knowledgeable about medical record documentation and triggers requiring RN intervention.
Telephonic interviewing skills and experience with a diverse population, including non‑English speaking.
Understanding of the impacts of SDOH.
Proficient with Microsoft Office (Excel, Outlook, Word).
Experience in a community social service or home‑health agency (preferred).
Experience in a nursing facility or Massachusetts Aging Access Service Point Agency (preferred).
Experience in a multidisciplinary care team (preferred).
Performance Requirements
Excellent communication and interpersonal skills with members and providers.
Exceptional customer‑service skills and a willingness to assist in timely resolution.
Excellent organizational skills and ability to multi‑task.
Adherence to policy and process requirements.
Independent learning skills and success with various learning methodologies.
Collaborative team player who demonstrates respect.
Willingness to learn about community resources and expand knowledge.
Proficiency in Excel spreadsheet management.
Accurate and timely data entry.
Effective care coordination and advocacy skills.
Strong problem‑solving, adaptability, and effective written communication.
Pay Range Disclosure In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $58,000 - $64,000 per year. Final compensation will depend on experience, skills, and fit.
Equal Employment Opportunity Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Job Details
Seniority level: Entry level
Employment type: Full‑time
Job function: Other, Information Technology, and Management
Industry: Insurance
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About Us Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high‑quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self‑expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio‑economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government‑sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All‑Inclusive Care for the Elderly)—in the region. Learn more at fallonhealth.org.
Overview The Navigator is an integral part of an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members. The Navigator partners with Fallon Health Care Team staff and other providers to always communicate what is occurring with the member and their status. The Navigator establishes telephonic and face‑to‑face relationships with the member/caregiver(s) and provider partners to better ensure ongoing service provision and care coordination, consistent with the member‑specific care plan. The Navigator may make in‑home or facility visits, as appropriate, to fully understand a member’s care needs.
Responsibilities
Utilize an ACD line to support the department and handle incoming/outgoing calls with the goal of first‑call resolution.
Conduct telephonic and, when necessary, face‑to‑face member visits to assess members using TruCare Assessment Tools.
Establish and develop effective working relationships with community partners (housing staff, adult day health care staff, assisted living staff, groups for adult foster care, rest home staff, long‑term care facilities, primary care providers) to facilitate member communication, represent Fallon Health positively, and grow membership in applicable products.
Educate members and PRAs about their product benefits and how to access them, often coordinating access.
Help members schedule and attend physician office visits.
Place referrals and follow up to ensure services are in place per the individual care plan, and develop care plans with the Care Team; send member‑specific care plans per process.
Perform care coordination, adhering to contact and duration frequencies, documenting all activities in TruCare with correct assessment and note type following Clinical Integration Documentation Policy.
Contact members to resolve gaps in care (e.g., PCP assignment, verification, preventive screenings, vaccination reminders).
Assist members in obtaining access to care, arranging appointments, and following up to ensure attendance, identifying barriers and enabling attendance.
Facilitate transportation for medical, behavioral health, and social appointments by educating members and, where required, completing the MassHealth PT‑1 process.
Educate members and help obtain community benefits (food via EBT, fuel assistance, WIC).
Screen members for social determinants of health (SDOH) and refer to Clinical Team members and partners for intervention based on criteria.
For maternity members, facilitate delivery of items from the “Oh Baby” program and coordinate after‑care needs with Nurse Case Managers.
Refer to the Nurse Case Manager or PCP when clinical decision‑making is required.
Qualifications HS Diploma/GED required. College degree (BA/BS in Health Services or Social Work) preferred.
2+ years in a managed care company, medical‑related field, or community social service agency.
Understanding of hospitalization experiences and post‑discharge needs.
Knowledgeable about medical terminology and common disease processes.
Knowledgeable about medical record documentation and triggers requiring RN intervention.
Telephonic interviewing skills and experience with a diverse population, including non‑English speaking.
Understanding of the impacts of SDOH.
Proficient with Microsoft Office (Excel, Outlook, Word).
Experience in a community social service or home‑health agency (preferred).
Experience in a nursing facility or Massachusetts Aging Access Service Point Agency (preferred).
Experience in a multidisciplinary care team (preferred).
Performance Requirements
Excellent communication and interpersonal skills with members and providers.
Exceptional customer‑service skills and a willingness to assist in timely resolution.
Excellent organizational skills and ability to multi‑task.
Adherence to policy and process requirements.
Independent learning skills and success with various learning methodologies.
Collaborative team player who demonstrates respect.
Willingness to learn about community resources and expand knowledge.
Proficiency in Excel spreadsheet management.
Accurate and timely data entry.
Effective care coordination and advocacy skills.
Strong problem‑solving, adaptability, and effective written communication.
Pay Range Disclosure In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $58,000 - $64,000 per year. Final compensation will depend on experience, skills, and fit.
Equal Employment Opportunity Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Job Details
Seniority level: Entry level
Employment type: Full‑time
Job function: Other, Information Technology, and Management
Industry: Insurance
#J-18808-Ljbffr