The OccuNet Company · 11 hours ago
Regional Director of Care Navigation (On-Site)
Amarillo, Texas
Full-time
Onsite
Lead/StaffThe OccuNet Company is an innovative healthcare cost‑containment organization committed to improving access to affordable, high‑quality healthcare. As the Regional Director of Care Navigation, you will provide members with exceptional support by delivering high-quality, professional, and efficient service, while liaising with members and providers to assist in the coordination of care related to medical access complexities.
Health CareInsurance
Responsibilities
Answer incoming calls and support members in scheduling appointments and accessing appropriate care
Maintain open, continuous communication between members and providers
Research accepting physicians or facilities based on plan design, member needs, and access barriers
Partner closely with Account Management, Contracting, Advocacy, Pre-Neg, and TPA teams to resolve access issues
Own the end-to-end member experience—from intake through resolution ensuring timely follow up, documentation, and clear next steps
Make outbound calls to providers, clients, and partners to gather information, educate stakeholders, and provide updates
Attend training and team meetings to stay current on workflows, tools, and plan updates
Deliver a high‑empathy, member‑first experience in every interaction
Acknowledge frustration, build trust, and help members confidently navigate their benefits
Explain open‑network plans, reference‑based pricing, and member benefits in simple, jargon‑free language
Own each case through resolution with proactive updates and follow‑through
Document all interactions thoroughly and accurately to ensure continuity of care, compliance, and quality
Liaise professionally with providers to clarify plan details, payment processes, and network structure
Navigate provider pushback with calm, respectful communication
Identify accepting or RBP‑friendly facilities and provide alternative options when needed
Coordinate Single Case Agreements (SCAs) or escalations based on internal criteria
Investigate delays or barriers that threaten timely care and act decisively to overcome them
Follow established workflows, boundaries, and escalation protocols with precision
Use internal research tools (OnPoint, PON, provider lookup systems) to verify provider options
Prioritize inquiries based on urgency, member risk, and available details
Collaborate across departments to establish processes that remove barriers to care
Uphold compliance standards, including HIPAA and Department of Labor guidelines
Maintain confidentiality of all sensitive information
Understand key clinical terms, service types, and the implications of delays in care
Confidently communicate around pre‑authorization processes, diagnosis implications, and provider requirements—without crossing clinical boundaries
Recognize scenarios requiring escalation due to potential impact on timelines or safety
Qualification
Required
High school diploma or equivalent required
Foundational understanding of medical cost containment products (RBP, out‑of‑network, access coordination)
Exceptional verbal and written communication skills
Empathy, emotional resilience, and the ability to stay calm under pressure
Strong judgment and ability to navigate sensitive or ambiguous situations
Persistent, detail‑oriented, and committed to accurate documentation
Ability to manage multiple tasks simultaneously and adapt to frequent changes
Skilled in problem‑solving and anticipating member needs
Preferred
Knowledge of CPT codes, claims forms, or general medical insurance preferred
Experience in healthcare navigation, patient access, medical office operations, insurance verification, case management, or high‑emotion customer service environments strongly preferred
Bilingual (Spanish) preferred
Benefits
401(k) with matching
Dental insurance
Health insurance
Vision insurance
Health savings account
Paid time off
Company
The OccuNet Company
The OccuNet Company is an innovative healthcare cost containment company that offers out-of-network solutions (OccuNet), reference-based pricing (Fairos), and pharmacy benefits management (FairosRx).
Founded in 1998
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Scott Arlotta
Senior Vice President of Strategy and Business Development
Company data provided by crunchbase