Recovery Support Navigator (R8472) - Point32Health : Job Details

Job Summary

Under the oversight of the Manager of Behavioral Health Care Management, the Recovery Support Navigator is responsible for working with members impacted by substance use disorder (SUD). This role serves to assist members with engaging in continued community-based substance use treatment and support following inpatient care, securing plan benefits, programs, and services across all products and lines of business. This role will work closely with substance use providers in the community to help bridge members to care management internally upon discharge from substance use facilities.

Key Responsibilities/Duties – what you will be doing

• Provide ongoing case management to high-need, high-risk members diagnosed with a substance use disorder, including those with medical comorbidities and social determinants of health (SDOH) that make acceptance into care challenging.
• Administer assessments and surveys, collaborate with the member/caregiver and providers to develop a plan of care, implement member-specific care manager interventions, and evaluate plan of care and revise as needed.
• Facilitate program enrollment utilizing key motivational interviewing skills.
• Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member's care.
• Perform telephonic and face-to-face outreach to assess barriers to wellness, medical, behavioral, and provide ongoing case management to high-need, high-risk members diagnosed with a substance use psychosocial needs of the member's care.
• Work with members impacted by SUD to proactively help navigating the SUD treatment system, engage into a plan of care, and access available tools, materials, programs, and services.
• Serve as an internal subject matter expert on SUD treatment, resources, regulations, and outside agencies, and participate in multi-disciplinary team meetings to consult on high-need or high-visibility cases.
• Consult and collaborate with other internal or external care managers providing support to member.
• Engage SUD facilities in identifying members and advocating for them to participate with care management post discharge.
• Identify and provide resources dedicated to addressing social determinants of health (SDOH).
• Serves as a resource and consultant to members, their families, providers, and Designated Facilities regarding all lines of business behavioral healthcare benefits, services, and systems, as well as the care available in the benefit-covered network and in the community by connecting with resources needed to succeed in community and not be readmitted.
• Focuses on optimizing the member's /family's level of independence in navigating the healthcare system at all levels of the continuum and in managing the member's condition.
• Work with each line of business within their own model of care, each interdisciplinary team members internally/externally (Senior Products, Public Plans, Medicare and Commercial).
• Meet productivity, documentation, quality, accreditation, and compliance standards.
• Other duties and projects as assigned.

Qualifications – what you need to perform the job

• Licensed Drug and Alcohol Counselor (LDAC) is required.

Education

• Required (minimum): Associate's degree or above required.

• Preferred:

Experience

• Required (minimum): 3 years of experience in an addictions or behavioral health setting working with individuals in recovery or with behavioral health challenges. Knowledge of community resources, substance use disorder, and recovery processes.

• Preferred: Experience with case management and population health strongly preferred. Previous experience in a managed care setting strongly preferred.

Skill Requirements

• Proven ability to lead a team while balancing the needs of the business including timelines and key performance indicators.
• Strong understanding and application of Care Management documentation system and other software applications needed to perform job functions.
• Excellent written and verbal communication, time management and organizational skills
• Strong interpersonal skills: ability to foster relationships with individuals at all levels internally and externally (e.g., nurses, social workers, community health workers, leadership, etc.)
• Bilingual highly desirable.
• Receptive to feedback.
• Self-motivated and able to work independently and set priorities.
• Strong understanding of the managed care environment with focus on the Medicaid Medicare and Commercial populations.
• Knowledge of community resources to address basic needs such as housing, food, transportation, clothing etc.
• Knowledge of barriers encountered by low-income and culturally diverse families.
• Working knowledge of Microsoft Office applications,

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• Ability to make face to face visits (member home, provider practices, facilities) as needed to meet the member needs and produce positive outcomes.
• Valid Driver's license and vehicle in good working condition as some travel required.
• May be required to work additional hours beyond standard work schedule.

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Compensation & Total Rewards Overview

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Scam alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact [email protected].

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.