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Job Description
Resp & Qualifications PURPOSE:
The Community Health Navigator serves as a frontline, member-focused role responsible for engaging Medicare and Medicaid members to support quality improvement initiatives, close gaps in care, and improve overall health outcomes. This position directly supports organizational performance related to NCQA accreditation standards, HEDIS quality measures, and CMS requirements through targeted outreach, education, and care navigation activities. The Community Health Navigator works in the community directly with members to identify unmet preventive, chronic, and follow-up care needs, including screenings, medication adherence, and condition-specific interventions. By conducting proactive outreach and facilitating access to providers and services, the Navigator plays a key role in closing documented care gaps that impact HEDIS and CMS quality measures. This role requires candidates to be located in the Maryland, Washington, DC, or Northern Virginia (DMV) area and who are willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.
ESSENTIAL FUNCTIONS
Act as a liaison to ensure members are connected with appropriate care channels (i.e. pharmacy, insurance, billing, referral) and have the information they need to successfully navigate their care journeys. Outreach and follow-up with patients in between episodes of care as appropriate to promote a seamless and predictable healthcare experience. Ensure that member went to appointments and assist with coordination for transportation and pharmacy needs. Collect all information and relay to Care Coordination team.
QUALIFICATIONS
Education Level:
High School Diploma or GED.
Experience:
3 years community relations/outreach/ customer services/ health educator role.
Preferred Qualifications :
Community Health Worker Certification Knowledge, Skills and Abilities (KSAs) Strong written and verbal communication skills. Problem-solving skills to tackle various tasks and challenges.
Salary Range:
$39,024 - $71,544 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Federal Disc/Physical Demand Note:
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship. #LI-NH2
