Care Connector

Responsibilities

Under the direction of the designated Supervisor, this position is responsible for providing select program interventions according to established health management program guidelines and the Member population. The Care Connector functions with direction from the program’s Case Managers or Supervisor / Manager and is responsible for screening identified Members based on Plan stratification for the program. Interacts with Members, providers and other AmeriHealth Caritas Family of Companies staff to implement program interventions, document activities and refer risk appropriate Members to professional staff according to protocols.

The Care Connector is also responsible for supporting program interventions of the care management department. Such associates will use good communication and listening skills to conduct both inbound and outreach calls, collect data according to scripts as applicable, script, tools, and protocols meeting both productivity and performance expectations as identified. The Care Connector may perform in a contact center environment, effectively processing calls from Members, providers, and other departments both internal and external to the company. The Care Connector elicits information from Members through surveys and questionnaires provided by the care management platform and identifies Members with Care Gaps / HEDIS related health conditions and social determinants of health needs. This associate will assist these Members in accessing care through health plan benefits and community resources. Under the direction of the Care Management staff, the Care Connector may provide Members with educational materials and carry out strategies to increase adherence to treatment and reduce barriers to care.

• Supports, identifies, communicates directly with Members to identify needs and provide information on health care access and preventative health interventions and screening.
• Supports the Members with non-clinical functions such as, but not limited to, identifying, and linking to community resources, and scheduling appointments.
• Performs research using the internet and processed claims to identify alternate phone numbers from providers, pharmacies, and other members of the care team.
• Develop a working knowledge and maintain timely, complete, and accurate documentation of Members interactions in AmeriHealth Caritas Family of Companies (ACFC) electronic care management platform, policies, standard operating procedures, workflows, Members insurance products and benefits, NCQA and regulatory requirements, along with community resources, programs and Electronic Visit Verification system.
• As applicable, support daily workflows with an emphasis on a positive workplace environment, through concise and timely interactions with staff, facilities, vendors, and providers to support our culturally and demographically diverse Member population.
• May process, maintain and close all incoming and outgoing correspondences / faxes in accordance with required standards and within respective timeliness guidelines. Refers to the appropriate clinical team members for review as defined by workflow.
• Appropriately processes or triages calls from Members and providers as well as processing urgent scanning, mailing requests and documentation retrieval as applicable.
• Demonstrates a professional and courteous manner when communicating with others with the ability to state clearly and accurately the agreed upon resolution.
• Complies with ACFC and HIPPA confidentiality standards to protect the confidentiality of Members information.
• Adheres to ACFC Policies & Procedures, process standards, Standard Operating Procedures and maintains current knowledge of Members benefits, rights and responsibilities and support the ACFC Mission & Values.
• Performs other related duties and projects as assigned within the identified timeframes.

Education / Experience :

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable being themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, Paid Time Off (PTO), holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more.

Generous paid time off and paid volunteer time off.

Employer-matched 401(k) and additional non-elective contributions, starting on day one.

Medical, dental, and vision plans — with coverage starting on day one.

Employee assistance programs, fitness reimbursements, nutrition counseling, and more.

Employer-paid life insurance, with opportunities to purchase additional coverage.

Employer-paid short-term disability coverage and long-term disability coverage.

Tuition assistance, including reduced tuition at certain schools.

Financial assistance with adoption, including paid time off.

Flexible spending and health savings accounts to pay for qualified expenses.

Discount programs on entertainment, travel, and more.