Medical Mutual of Ohio Quality Care Navigator in Cleveland, Ohio

Location:Cleveland, OH Headquarters

Reports To:Manager

Job Summary

Works proactively with the cross disciplinary team (Customer Service, Case Management and Quality), to provide outreach services to Medicare members and ACA population. Assists with navigation of health care services and community resources, benefits optimization, peer support and other relevant services. The Quality Care Navigator helps to identify social, cultural and demographic barriers to achieving health outcomes, maximizing self-management, and promoting wellness for MMO government programs population.


Essential Functions

  • Participate as a member of MMO multi-disciplinary team to provide outreach services to Medicare members and other government programs populations. Provide service coordination and linkage, including activation of benefits, medical services, culturally specific resources, and peer support.

  • Identify members with social or demographic barriers to receiving health care or optimizing health outcomes. Such identification will be through various risk stratification tools and referrals from customer service and care management.

  • Develop relationships with community resources and create a library of interventions that can assist members in self-management and accessing necessary health and social services.

  • Implement Member Advisory Group for Medicare Advantage members at MMO, including promoting access to peer support services.

Education and Experience


  • BA/BS in Social Services or Behavioral Health or equivalent social services work in aging or disabled community.

  • Masters in Social Work preferred

  • Minimum of two years experience in care coordination activities either in a clinical setting or health plan.

  • Experience in working with seniors and disabled populations.

Technical Skills and Knowledge

  • Understanding of aging process, including the psychosocial sequelae of aging, and the social systems and processes used to help the aged and disabled to access health resources and optimize health outcomes.

  • Proficiency with Microsoft Office Applications.

  • Knowledge of community resources for aging and disabled population.

  • Knowledge of motivational interviewing techniques, experience preferred

  • Knowledge of medical terminology.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:

Top Workplace in Northeast Ohio. Five years in a row we’ve received this recognition!

· On-site wellness center and massage. Enjoy personal trainers, towel service,b locker room, weight room, elliptical machines, and a variety of classes!

· On-site cafeteria serving hot breakfast and lunch. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily.

· Convenient store.

· Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member.

· Business casual attire.

Excellent Benefits and Compensation:

· Competitive compensation plans.

· Employee bonus program.

· 401(k) with company match and an additional company contribution.

· Excellent medical, dental, vision, and disability insurance.

An Investment in You:

  • Career development programs and classes.

  • Mentoring and coaching to help you advance.

  • Education reimbursement up to $5K per year.

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We’re the largest health insurer in Ohio and for 80 years, we’ve been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

/At Medical Mutual we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status./

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/We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing./

Job: *7 - General Staff

Organization: *Managed Care

Title: Quality Care Navigator

Location: OH-Cleveland

Requisition ID: 1700235