Redpoint

At Collective Health, Care Navigation plays a crucial role in helping people get the right support, at the right time, across a wide range of complex health needs. Care Navigation is a comprehensive care management program made up of our team of pharmacists, social workers, nurses, dietitians, and care coordinators that support people dealing with chronic or serious illnesses by guiding them on their journey to help them understand and navigate the disjointed U.S. healthcare system. In joining our Care Navigation team, you’ll have the important role of helping our members achieve better health at a lower cost. You will report to the Manager of Care Navigation.

What you'll do:

• Leading outreach efforts to high-risk individuals through telephonic or electronic outreach
• Completing telephonic assessments and creating goal oriented care plans for members enrolled in the program, and supporting the members as they work to achieve those goals.
• Use evidence-based medicine and professional guideline recommendations to improve members’ health through interventions including but not limited to: suggesting formulary alternatives to ask about, coaching on medication adherence strategies, coordinating receiving medications through lower cost of care settings, working with providers to address drug interactions or adverse drug reactions, recommending dosage adjustments to optimize therapy, identifying opportunities for preventive care like immunizations and cancer screenings, etc.
• Educating and empowering members using decision support through multiple modalities including telephone and email
• Provide accurate documentation of member assessments and follow up member interactions
• Identification of opportunities for maximizing value on medical and pharmacy health plan benefits
• Collaborate with other clinicians on the Care Navigation team on a daily basis and presentation of complex cases to the medical director on a monthly basis
• Provide subject matter expertise to support the Collective Health operations teams in response to complex or escalated pharmacy inquiries
• Other duties as assigned

To be successful in this role, you'll need:

• A PharmD
• Minimum of 2 years experience in a PBM, hospital or clinic, retail pharmacy, health plan, or other managed care setting
• Having 2-3 years experience in Medication Therapy Management, Clinical Specialty Programs, experience at a payer (PBM, TPA, health plan, etc.), or residency training is preferred
• Bilingual Highly Preferred: (English/Spanish) or (English/French)
• You are passionate, empathetic, and excited to help people
• You are independent, tenacious, and capable of identifying and implementing best practices
• You are capable of thinking creatively to implement care navigation solutions that challenge status quo
• You are driven, able to carry a caseload and prioritize to complete daily tasks and outreach
• You are tech savvy; able to talk, type, and navigate an electronic chart with ease
• You’re okay with working in a telephonic role (no direct/face to face patient contact)
• You are a problem solver using best practices to achieve goals
• You are comfortable with ambiguity and open to collaborating with people across different teams
• A strong moral compass and commitment to Collective Health’s core values of integrity, transparency and trust

Pay Transparency Statement

This is a hybrid position based out of our Plano or Lehi office, with the expectation of being in office at least 2-3 weekdays per week, depending on location.#LI-hybrid

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.