Network Navigator

The Network Navigator is responsible for proactively guiding health plan members to appropriate, high-quality, in -network providers to improve access to care, reduce leakage, and enhance member experience. This role serves as a key connection point between members, providers, and internal teams to overcome access barriers, schedule appointments, and ensure timely, coordinated care within the plan’s provider network. The Network Navigator will work with Utilization Management, case management, and provider/facility-based discharge planners to ensure access and guidance to in-network facilities and providers to reduce the administrative burden on members and reduce out-of-network utilization, when appropriate., Member Navigation & Access to Care

• Proactively assist members in identifying and accessing in-network primary care, specialty care, and ancillary services
• Educate members on the benefits of using in-network providers, including cost savings and continuity of care
• Support appointment scheduling, follow-ups, and referrals to reduce delays in care
• Assist members facing access challenges (e.g., provider availability, geographic barriers, transportation, language needs)

Network Utilization & Leakage Reduction

• Identify and address out-of-network utilization drivers and work to redirect care to in-network providers when clinically appropriate
• Collaborate with utilization management, care management, and provider relations teams to close network gaps
• Monitor member interactions to identify high-risk leakage patterns and access barriers

Provider Coordination

• Coordinate with provider offices to confirm network participation, availability, and appointment scheduling
• Assist providers with member onboarding, referral workflows, and benefit clarification when needed
• Escalate provider access or capacity issues to Network Management or Provider Relations

Member Education & Engagement

• Explain health plan benefits, referral requirements, and network rules in clear, member-friendly language
• Serve as a trusted point of contact to reduce member confusion and frustration
• Support new members, high utilizers, and members with complex needs during care transitions

Documentation, Tracking & Reporting

• Document member outreach, navigation activities, and outcomes in care management or CRM systems
• Track metrics related to access to care, appointment completion, network utilization, and member satisfaction
• Identify trends and provide recommendations for network optimization and member engagement strategies

Collaboration & Quality Support

• Partner with clinical teams, quality improvement, care management, and customer service to support integrated member care
• Support health plan initiatives related to access standards, CAHPS improvement, and regulatory compliance
• Participate in interdisciplinary meetings and quality improvement efforts

• Bachelor’s Degree required; experience can be considered in lieu of a degree, * At least 1-2 years of social work, case management, or related field, ideally in a clinical setting, preferred
• At least 2-4 years of experience in healthcare navigation, care coordination, member services, or managed care highly preferred
• Strong understanding of health plan provider networks, referral and authorization processes, and member benefits and access requirements highly preferred, * Experience in a health plan, managed care organization, or population health program
• Clinical background (RN, LPN, or allied health professional) strongly preferred
• Experience working with Medicaid, Medicare, or dual-eligible populations
• Familiarity with network adequacy, access standards, and compliance requirements

Knowledge, Skills, and Abilities

• Strong knowledge of healthcare resources, community services, and patient advocacy.
• Excellent communication and interpersonal skills.
• Ability to collaborate effectively with healthcare professionals across multiple disciplines and experiences.
• Strong organizational and time management skills.
• Familiarity with electronic health records and case management software.

Pulled from the full job description

• Health insurance
• Opportunities for advancement, We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more., * This is a full-time role with a Monday through Friday, 8:30-5 PM EST schedule, At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham., Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills., At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.