Regional Director of Care Navigation; On-Site

Overview

The Occu Net Company is an innovative healthcare cost‑containment organization focused on reducing the cost of healthcare while maintaining high‑quality patient experience. We emphasize an outward mindset culture based on empathy, mutual respect, and seeing one another as whole people. We are growing quickly and seeking team members excited about professional growth in a fast‑paced environment.

Job Title
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Regional Director of Care Navigation

Job Summary
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As the Regional Director of Care Navigation, you will provide members with exceptional support by delivering high‑quality, professional, and efficient service. You will liaise with members and providers to assist in the coordination of care related to medical access complexities.

About The Occu Net Company (TOC):
The Occu Net Company is a healthcare cost‑containment organization committed to improving access to affordable, high‑quality healthcare. We value empathy, respect, and seeing one another as whole people in a fast‑paced, growth‑oriented environment where continuous learning and collaboration drive success.

We value a positive attitude, problem‑solving abilities, patience, and a team‑oriented mindset that enables excellent customer service even in challenging situations. Our culture emphasizes growth and collaboration, contributing to low turnover.

• 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 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 with 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.

• High school diploma or equivalent required.
• Foundational understanding of medical cost containment products (RBP, out‑of‑network, access coordination).
• Knowledge of CPT codes, claims forms, or general medical insurance preferred.
• Experience in…