COMPLEX NAVIGATION FAQ
Navigators are the member's single point of contact and provide concierge support for members.
TRUE or FALSE?
FALSE: Members have fulltime access to our Advocates for their everyday needs, and Navigators support members for only brief periods of time to close NBAs and to honor all open activities while the member is actively engaged. Once a member is no longer considered high priority, they will no longer be assigned to a navigator until additional gaps in care are identified.
What do I do if a member requests a different Navigator or requests to have a Navigator who is in the United States?
Apologize for any difficulties that the member has experienced. Remain positive. Be diplomatic and even-tempered, even if the caller is not. Advise the member that you cannot request a different Navigator, but you are available now to assist them with any needs they have.
If the member states they do not want anyone to contact them, follow the direction in Member Materials - Do Not Contact.
If the member expresses dissatisfaction, document the grievance. Refer to Grievance Handling (Medicare and DSNP) - Complaints Appeals and Grievances.
If the member requests to escalate the call, refer to Escalated Calls and Issues. If the member becomes abusive or disruptive, refer to Situational Guidelines - Dissatisfied Members.
What is a Navigator responsible for each day?
Each day the Navigator is responsible for:
Reviewing and updating their IEX schedule
Filling out their timesheet
Reviewing their Outlook Calendar for items such as meetings, member commitments etc.
What are the five colors associated with activity status?
Red: past due
Yellow: due today
Green: future date
Blue: outcome selected indicating the activity is closed/resolved
Gray: static question. This question will not be placed on the timeline or Follow Up Page unless a date is selected. This is optional due to a static question needed to exist for the tab to be present on the NavPlan.
How does the Navigation Dashboard sort the members?
The navigation dashboard sorts members by priority, with those having the most urgent needs at the top. The priority list is refreshed daily and updated in real-time based on recent outreach. Always contact members from top to bottom to address urgent needs first.
What is Complex Member Navigation?
Complex Member Navigation is a customer service model which provides a proactive approach to care. The goal of navigation is to close gaps in care and ensure members are taking an active role in their health through targeted outreach programs.
We should provide the member with their Navigators full name, email, and extension if requested?
TRUE or FALSE?
FALSE. To protect the privacy of our Navigators, NEVER provide the Navigator’s full name, email address or extension. First name and initial of their last name is all that should be given to members.
What is the NavCloud/Inbound Call Greeting?
Thank you for calling UnitedHealthcare. My name is <Your Name>. <If applicable, thank the member for verifying their information through the IVR.>
Who do I have the pleasure of speaking with today?
How may I assist you?
Where can the NavPlan be launched from?
The NavPlan can be launched from the Member List or from the Navigate4Me tab in Maestro. The NavPlan is an interactive list of activities for a specific member. The NavPlan will allow activities to be created, tracked, and closed. Activities will be listed in the order they were added with the most recently added at the top of each category and tab. Activities can be updated directly from the NavPlan.
Select the Navigate4Me Tab to open the NavPlan from the member's account.
What members should we NOT be contacting?
Do Not Contact the following members and disposition the Wrap-Up as No Contact Attempt Made:
Disenrolled members
Members in hospice care, skilled nursing facilities, and long-term care facilities
Members without NBAs.
Declined Outreach status. This status is used to indicate no further calls will be made
Navigators call members to just check in or to celebrate milestones.
TRUE or FALSE?
FALSE.
Navigators' time is spent exclusively on members who need help closing NBAs and other issue resolutions during those specific interactions. This allows our Navigators to reach more members who need help managing their care.
How do you identify if a member has a Navigator assigned?
You will no longer see the Navigator’s name in the banner in Maestro. To identify if a member has a Navigator, you will need to look for the Navigate4Me Tab. If the tab is not present, then the member is currently not assigned to a Navigator.
If you see notes from a Navigator under Recent Interactions, this does not mean that the member is still assigned to a Navigator or is assigned to the Navigator who made the notes. Do not reach out to a Navigator in Teams or in Outlook. Please only follow the Navigator Hand-Off process below to hand-off an issue.
What are the priorities of a Navigator?
Priorities:
What are the 2 main parts of the NavPlan?
Declined Outreach: Check box allowing the Navigator to add or remove the Declined Outreach Status.
NavPlan Tabs: These tabs are used to organize Activities.
What are the objectives of the outreaches to members?
Complete Next Best Actions
Work through all identified member needs
Should the term "Navigate4me" be used when speaking with members?
Navigate4Me is an internal term and should NOT be used when speaking with members.
When is it inappropriate to route to the Navigator?
Non-Nav Activities when assistance has not been offered and documented first. Only complete a Non-Nav activity if the member is demanding Navigator contact.
Callbacks to members in response to a dropped call. Dropped calls must be attempted real-time. Follow the Situational Guidelines - Disconnected Callback job aid.
Calls without a verified phone number. Make sure to verify with the caller and document that the phone number was verified.
You have already resolved the member's issue.
Grievances are resolved by the Advocate/Navigator receiving the complaint. Any follow up is done by Advocate/Navigator who received the call. Compliance items are not to be transferred to the Navigator.
DO NOT reach out to Navigators via Microsoft Teams or Email to communicate member outreach or follow-up requests. Doing so will delay timely assistance for the member.
What is the NavCloud/Inbound Call Closing?
Is there anything else I can help you with today?
Thank you for calling UnitedHealthcare. Have a wonderful day!
What is the difference between a member commitment and a follow up?
Member commitments: activities that are tracked for Issue Resolution within 48 hours
Follow-ups: activities that require more than the standard commitment time to resolve due to circumstances outside of your control
How should we be documenting calls per general call handling?
HOW ARE MEMBERS IDENTIFIED FOR NAVIGATION?
members are identified for Navigation support based on STARs priority contracts and social risk factors. Only members who are identified by the STARs team and have open NBAs will be assigned to a Navigator. Every night, an updated file from the STARS team prioritizes members based on the number of NBAs they have open, the weight of each NBA and the importance of the NBA to the contract the member is enrolled in. The file also considers the ease of action required to close the NBA gap.
What is the second step to follow if you receive Non-Nav Activity in error?
The Navigator will send the following details to their Team Lead/Supervisor:
What is the primary responsibility of a Navigator?
A Navigator's primary responsibility is to work on their Navigation Dashboard panel.
The Panel refreshes daily to display the members with the highest needs. Work the Panel from top to bottom to engage members with important and urgent open gaps that have not had a recent outreach.
What is the definition of the NavPlan and what is it used for?
Allows the Navigator to access the member's NavPlan. This allows the Navigator to document any follow ups needed for the member.
What is the suggested scripting when making a member outreach?