SCO Care Navigator - Lawrence - Khmer preferred
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At a glance
Requirements
Credentials this posting asks for.
Job overview
Fallon Health is hiring a SCO Care Navigator - Lawrence - Khmer preferred. The SCO Care Navigator at Fallon Health coordinates member care, conducts phone and in‑person assessments, updates care plans, and removes barriers to services. Working with an interdisciplinary team, the Navigator educates members on benefits, advocates for access, and ensures compliance with regulatory standards while maintaining knowledge of program policies and community resources.
Key focus areas include Conduct phone and in‑person assessments using TruCare, Coordinate care needs and schedule appointments, and Educate members on benefits, coverage, and appeals.
Successful candidates bring Understanding Of Hospitalization And Post‑Discharge Needs, Working Knowledge Of Medical Terminology, and Motivational Interviewing Experience. Important skills include Microsoft Office, Excel, Outlook, Microsoft Word, Motivational Interviewing, and Working With Diverse Populations. Preferred (not required): TruCare, Khmer, Culturally Responsive Communication, and Care Coordination.
Skills & qualifications
Skills
Qualifications
Full job description
Overview
About us:
Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
Brief summary of purpose :
The Navigator–Care Management is part of an interdisciplinary care team that coordinates care, improves access, and supports quality outcomes for NaviCare members. The Navigator builds relationships with members/caregivers via phone and in person, conducts home visits as needed, helps implement care plan interventions, and works to remove barriers to care. In partnership with the Nurse Case Manager, the Navigator updates care plans and provides holistic case management for low-, moderate-, and high-risk members.
Responsibilities
Primary Job Responsibilities
Member Education, Advocacy, and Care Coordination
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Conduct phone and, as appropriate, in-person assessments, screenings, and visits using TruCare; update individualized care plans and aim for first-contact resolution in a culturally responsive manner.
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Coordinate and follow up on care needs, including post-transition outreach, appointment scheduling, medication support, and service monitoring.
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Educate members/representatives on benefits, coverage criteria, rights, appeals, authorizations, and evidence of coverage.
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Identify and address gaps in care (e.g., PCP assignment, preventive screenings, vaccinations) per established protocols.
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Screen for social determinants of health and refer to community resources (e.g., food, housing, fuel assistance, transportation); escalate clinical decisions to the Nurse Case Manager or PCP.
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Advocate for members’ access to covered benefits and coordinate with community agencies for non-covered supports.
Provider Partnerships and Collaboration
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Participate in—and as appropriate, lead—care plan meetings with providers, partners, and care team members.
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Collaborate with the interdisciplinary team (e.g., LTC, behavioral health, advanced practitioners, community partners) to support coordinated care.
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Build effective working relationships with community partners and providers (e.g., housing, ADH, assisted living, LTC facilities, PCPs) to support timely, member-specific communication.
Access to Care
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Submit and track requests/authorizations for covered services; ensure accuracy and timeliness per program workflows.
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Educate members and providers on authorization processes and help resolve authorization issues.
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Facilitate access to medical, behavioral health, and social services, including arranging transportation when needed.
Care Team Communication
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Communicate timely updates with members, caregivers, providers, and internal teams on care plans, service changes, and member status.
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Partner with LTC and community teams during admissions, transitions, and discharges to ensure continuity of care.
Regulatory Requirements, Documentation, and Reporting
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Complete required activities to meet CMS/State, NCQA, HEDIS, and other standards (e.g., welcome calls, screenings, care plans).
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Document accurately and on time in TruCare and related systems; review and validate member panel data and reports.
Additional Responsibilities
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Maintain knowledge of program benefits, policies, procedures, and community resources.
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Support operations by covering assignments, adapting to priorities, and completing other duties as assigned.
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Mentor or train staff on job-related processes and workflows, as assigned.
Qualifications
Education
College degree (BA/BS in Health Services or Social Work) preferred
License/Certifications
License: N/A
Certification: Community Health Worker - preferred
Other: Satisfactory Criminal Offender Record Information (CORI) results
Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:
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Must possess a valid drivers’ license
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Must attest to no disqualifiers per Driver Safety Policy
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Must possess and provide proof of minimal state required auto insurance
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Must have reliable transportation
Education
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2+ years’ experience in managed care and/or community-based health and human services (e.g., home health, personal care management, independent living, ASAP, or relevant state agencies) preferred
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Understanding of hospitalization and post-discharge needs required
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Working knowledge of medical terminology, common conditions, and medical record documentation; able to identify triggers requiring RN intervention required
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Motivational interviewing experience and ability to work effectively with diverse and non-English-speaking populations required
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Understanding of social determinants of health required
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Proficiency with Microsoft Office (Excel, Outlook, Word) required
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Experience with face-to-face member visits and working with providers/community partners preferred
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Experience working on a multidisciplinary care team within a managed care organization preferred
Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $28/hr - $30/hr which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
#P01
Location US-MA-Lawrence | US-MA-Lowell
Posted Date 1 month ago (7/20/2026 10:45 AM)
Job ID 8429
# Positions 1
Category Professionals
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