Director of Member Care Navigation

Director of Member Care Navigation

About Company

Samaritan Ministries is a Biblical solution to health care. It is not insurance. We deliver authentic, compassionate, and personal service in the name of Christ to enable and inspire members to provide for one another’s medical needs through prayer, encouragement, and financial support.

From demonstrating Christ-centered compassion to modeling best practices in health care sharing, Samaritan Ministries is committed to keeping Jesus at the center of everything we do. The way we interact with our colleagues and engage with our members is a testament that we are ultimately serving Christ and His Kingdom.

Summary

The Director of Member Care Navigation will serve the members of our organization by developing, implementing, and evaluating clinical care navigation pathways to ensure timely interventions and access to medical services. This role involves leading a team focused on delivering patient-centered care and building strong partnerships with healthcare providers to improve health outcomes for our members at an affordable cost. Additionally, the Director will be responsible for managing recruitment, training, and operational processes to optimize the efficiency and effectiveness of the care navigation team. The Director will also manage relationships with healthcare providers, analyze data to identify trends and opportunities, and provide Christ-centered leadership to ensure the ongoing health and success of department operations.

Competencies

• Planning and Organizing
• Fostering Communication
• Managing Resources
• Acting with Integrity, Empathy, and Compassion
• Collaborating with Others
• Neighbor Focus
• Pursuing Excellence
• Negotiating
• Problem Solving
• Business Acumen
• Partnering
• Financial Acumen

Key Responsibilities

• Create and execute a strategy of navigating clinical care to ensure members receive timely and effective medical interventions.
• Provide leadership and direction to the care navigation team, fostering a culture of high performance and continuous professional development.
• Establish and nurture relationships with healthcare providers and institutions to enhance the quality and accessibility of care for members.
• Monitor and evaluate the effectiveness of care navigation processes, implementing improvements to maintain high standards of service delivery.
• Oversee the recruitment, onboarding, and ongoing training of care navigation staff to ensure a skilled and efficient team.
• Develop and manage operational procedures to optimize the efficiency and effectiveness of the care navigation team.
• Ensure that care navigation services are provided in a financially sustainable manner, balancing quality care with cost management.
• Act as a representative for members, ensuring their needs are met and their voices are heard in the care navigation process.
• Utilize data to track performance metrics, generate insightful reports, and inform strategic decision-making.
• Ensure all care navigation activities adhere to relevant regulations, standards, and best practices.
• Negotiate new agreements and renegotiate existing ones with healthcare providers to secure fair and reasonable pricing for members.
• Review and analyze existing agreements and pricing from providers without agreements to identify areas of high value.
• Assist with the implementation and ongoing analysis of agreements, including data review, to ensure they meet performance expectations.
• Analyze reports for trends to better understand future areas of gain for the department.
• Oversee the operations and performance of the Provider Relations Department.
• Offer Godly, wise, and Christ-centered leadership to ensure the ongoing health and success of department operations.
• Develop, implement, manage, and monitor strategies and daily operations within the department.
• Ensure excellent communication standards within the department, with members, providers, and fellow staff.
• Work with the department to handle challenging member relationships, including issues with misused funds, errors, omissions, and extra money, ensuring proper stewardship of member funds.
• Manage systems and process improvement initiatives, ensuring high-quality service through necessary quality assurance controls.

Qualifications and Experience

• Four-year degree from an accredited university or the equivalent combination of education and experience.
• 5 years leadership or management experience in the health care industry.
• Experience in managing a remote/hybrid workforce a plus.
• Experience in a leadership role within care coordination, case management, or a similar healthcare setting.
• In-depth understanding of healthcare systems, clinical care pathways, and patient navigation processes.
• Knowledge of healthcare regulations, standards, and best practices.
• Proficiency in analyzing healthcare data, performance metrics, and generating reports.
• Understanding of contract negotiation principles and practices, particularly with healthcare providers.
• Knowledge of cost management and financial stewardship in a healthcare setting.
• Familiarity with quality assurance and process improvement methodologies.
• Strong leadership skills to manage and develop a high-performing team.
• Excellent verbal and written communication skills for interacting with members, providers, and staff.
• Ability to identify issues, analyze data, and develop effective solutions.
• Strong interpersonal skills to build and maintain relationships with healthcare providers and team members.
• Exceptional organizational skills to manage multiple tasks and projects efficiently.
• Effective negotiation skills to secure favorable relationships with healthcare providers.
• Ability to analyze complex data and trends to inform decision-making.
• Proficiency in planning, implementing, and monitoring projects and strategies.
• Ability to think strategically and develop long-term plans for care navigation.
• Flexibility to adapt to changing Healthcare environments and member needs.
• Keen attention to detail to ensure accuracy and compliance in all activities.
• Ability to understand and advocate for member needs and concerns.
• Strong decision-making abilities to guide the care navigation team effectively.
• Ability to work collaboratively with team members and other departments.
• Ability to provide Christ-centered leadership and set a positive example for the team.

Additional Information

• Tasks are normally conducted in a regular office environment, requiring use of computer and mouse and other standard office equipment. Staff usually remain in a stationary position, often standing or sitting for prolonged periods.
• Staff will observe safety principles while performing the duties of the position.
• Staff will be required to travel and have a valid driver’s license.
• May need to lift and move items up to 35 lbs on occasion.
• This position requires an active commitment to the mission and values of SMI. In the course of performing job duties, the employee will act in a manner that is Christ-honoring as well as Christ-like, demonstrating a personal Christian faith and witness in all interpersonal interactions.