Care Navigator

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Works proactively with a multi-disciplinary team (Customer Service, Case Management, Pharmacy and Quality), to provide telephonic outreach services to various Members (commercial, Medicare Advantage (MA), or Affordable Care Act (ACA)), coordinating care across the continuum with emphasis on the social barriers of the identified populations. Assists with navigation of health care services and community resources, benefits optimization, and other relevant services. Helps to identify social, cultural, and demographic barriers to achieving health outcomes, maximizing self-management, and promoting wellness for members across the care spectrum.

This position has the option to work remotely; Ohio residents preferred. Seeking applicants with Medicare/Medicaid experience.

Responsibilities

• Provides outreach services to various member populations (Commercial, MA, ACA). Coordinates service and linkage, including activation of benefits, medical services, and culturally specific resources.
• Assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness, guiding members/families. Facilitates interactions with resources appropriate for the care and well-being of members.
• Develops relationships with community resources and implements interventions that can assist members in self-management and accessing necessary health and social services.
• Ensures progress toward desired goals by continuously monitoring member through assessments and/or evaluations.
• Performs other duties as assigned.

Qualifications

Education & Experience

• Bachelor's degree in social services, behavioral health, or related field.
• In lieu of degree, may consider equivalent combination of education/training and experience.
• 2 years experience in care coordination activities preferably in a health plan/managed care and/or in a clinical setting.
• Experience working with populations that have complex biopsychosocial needs.

Professional Certification(s)

• Certification in Care Coordination or other industry recognized certification preferred.

Technical Skills & Certifications

• Intermediate Microsoft Office skills.
• Knowledge of national, state, and local government programs as well as community resources.
• Knowledge of community resources for various identified populations.
• Knowledge of motivational interviewing techniques
• Knowledge of medical terminology
• Basic knowledge of health insurance operations.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.