JOB SUMMARY

This job serves as a liaison and mediator between members, providers, community centers, and the Organization. Works independently in the community engaging members within a specific target population as defined by the Plan. Works face-to-face with members to provide basic health literacy, linkage to community resources, and assistance navigating the healthcare system and brings education and support to members in the community and serves as a healthcare advocate for members. The goal is to outreach and engage members to improve health outcomes, close care gaps and improve overall wellness by connecting members to providers and community resources and develop partnerships with community centers and local community based resources to support the needs of the members as well as the community. The incumbent works closely with the care management department to refer members for additional support and education beyond the job's scope of practice.

ESSENTIAL RESPONSIBILITIES

• Initiate outreach efforts, face-to-face, related to targeted preventive health, maternity, care transitions and chronic condition initiatives.
• Educate member(s) on the importance of targeted preventive health services, assess opportunity for care management intervention and make appropriate referrals, including referrals to the Behavioral Health Managed Care Organization (BHMCO) as needed. Contact member(s), providers and community agencies to coordinate access to preventive health services.
• Develop a rapport with members and community centers to establish a supportive relationship which empowers members to take an active role in their health and wellness.
• Assist members with completing a Health Risk Assessment, identifies/providing direction to managing healthcare barriers (i.e. knowledge deficit, transportation, financial), scheduling appointments, and answering questions.
• Collaborate with human services providers such as Head Start Programs, WIC, community centers, and homeless shelters; as well as state agencies such as Children and Youth Services (CYS) and juvenile probation in the identification and outreach to members in need of services.
• Understand the Organization's lines of business and benefits for members in order to provide accurate and current information to member in the community.
• Contribute to the development and preparation of educational materials for members and providers.
• Conduct provider and community training on Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services and other special preventive health initiatives.
• Provide summary and outcomes of training to management and peers.
• Participate in the development of programs that are effective, measurable and innovative, with a special emphasis on reaching at risk members.
• Represent the company at community events, including events sponsored by community centers.
• Other duties as assigned or requested.

EDUCATION

Minimum

• High School Diploma/GED

Substitutions

• None

Preferred

• None

EXPERIENCE

Minimum

• WV Clearances:

  *700.1 (Child Abuse & State Police clearance )

  *700.2 (Fingerprints & Federal background clearance)

  Chapter 700 WV clearance for access: Registry and employment screening (WV CARES )

Preferred

• Experience in a health care related customer service or marketing environment that would demonstrate the ability to positively impact the engagement of members in the organization's condition and case management programs
• Bilingual, Spanish speaking
• Basic medical terminology background
• Experience with the targeted community or population

SKILLS

• Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services
• The ability to interact well with peers, supervisors and customers and work as a team member
• Ability to solve problems independently and creatively and be proactive, self-directed, assertive and creative in problem solving and system planning
• Ability to handle many tasks simultaneously and respond to customers and their issues promptly
• Possess good written and oral communication skills
• Have an appreciation of cultural diversity and sensitivity towards the Medicaid population with demonstrated expertise in topics related to cultural competency including working with members with limited English proficiency. Be aware of issues members face related to healthcare including transportation, child care, lack of knowledge concerning preventive health, distrust of the system as well as other personal, social, financial barriers
• Must demonstrate patience and empathy when interacting with members and all internal/external customers

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• None

TRAVEL REQUIREMENT

50% - 75%

LANGUAGE REQUIREMENT ( other than English )?
None

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS

Position Type

Most On-The-Road

Teaches/Trains others regularly

Rarely

Travels regularly from the office to various work sites or from site-to-site

Frequently

Works primarily out-of-the office selling products/services (Sales employees)

Does Not Apply

Physical Work Site Required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.