Care Navigator

• Conduct case management on behalf of clients and Southern Scripts to manage specialty drug spending and generate savings
• Identify lowest-cost drug solutions while maintaining a high-touch, member-centric relationship
• Provide targeted, personalized service based on members’ benefits, health information, and engagement
• Coordinate site-of-service transitions and other RxCompass cost-saving methods
• Engage members and providers by telephone, written correspondence, fax, or app
• Consult and educate members and providers through individualized programs
• Help members understand claims, accumulators, usage, balances, and cost sharing
• Develop, present, and implement member-centric solutions that reduce specialty medication costs
• Handle referrals within required turnaround times
• Support client expectations for efficiency, service levels, privacy, and decision quality
• Maintain compliance with ERISA, HIPAA, and client-specific requirements
• Collaborate with medical and pharmacy providers, hospitals, members, home infusion providers, and other vendors
• Report HIPAA violations to the Compliance Officer and/or Human Resources
• Work as part of the team to meet business-unit objectives and adapt to change

Care Navigator jobs in Nebraska

Associate Care Navigator