Manager, Patient Navigation
Core
Leads day-to-day operations of a centralized, high-compliance call center function managing patient navigation workstreams including non-CPL requests, care plan non-adherence, and voluntary PCP switches.
Role type
Senior IC operations manager (healthcare call center)
Builds
Closed-loop documentation and compliance reporting for Medicare Advantage patient navigation tickets
Domain
Healthcare / Managed Care / Medicare Advantage
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Call center operations management, CMS Medicare Advantage compliance, team coaching and development, performance metrics analysis, cross-functional collaboration, HIPAA confidentiality, process improvement, data-driven decision making
Preferred skills
Healthcare operations experience, quality assurance/call-monitoring experience, experience with borrowed-resource staffing models, bilingual English/Spanish
Technologies
Microsoft Excel, case-management/CRM/QA software
Responsibilities
Manage staffing, scheduling, and workload distribution for Tier 1 and Tier 2 staff; oversee intake and triage across all workstreams; conduct call monitoring and documentation audits for 100% of recorded interactions; implement maker/checker controls for clinical determinations; coordinate Tier 3 clinical sign-off with Medical Director; track and report team performance metrics; coach and develop staff; collaborate with Community Nursing, Behavioral Health, and Enrollment operations; identify and escalate systemic operational issues; maintain standard operating procedures and QA scoring rubrics
Seniority
Manager, hands-on IC
