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Network Navigator
Job Location:
Job Location:
Somerville, NJ - USA
Hourly Salary:
$ 25 - 36
Hourly Salary:
Posted:
21 August 2026 (Yesterday)
Posted:
Application Deadline:
18 November 2026
Application Deadline:
Vacancies:
1 Vacancy
Vacancies:
Job Summary
Site: Mass General Brigham Health Plan Holding Company Inc.
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.
We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.
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 plans 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.
Primary Responsibilities:
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
Remote399 Revolution Drive40RegularDay (United States of America)8925 Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .
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.
Job Summary
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 worlds 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.
We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.
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 plans 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.
Primary Responsibilities:
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
Qualifications
Education
- Bachelors Degree required; experience can be considered in lieu of a degree
Experience
- 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
Preferred Qualifications
- 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 dualeligible 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.
Additional Job Details (if applicable)
Working Conditions
- This is a full-time role with a Monday through Friday 8:30-5 PM EST schedule
- This is a remote role that can be done from most US states
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$25.50 - $36.49/HourlyGrade
5EEO Statement:
Mass General Brigham Competency Framework
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.
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
