Community Care Coordinator

About Health Care Access Maryland (HCAM)

Health Care Access Maryland (HCAM) is a nonprofit organization dedicated to making Maryland healthier by connecting residents to health insurance coverage and providing comprehensive care coordination. Each year, HCAM assists over 80,000 individuals across the state, offering personalized guidance, health education, and advocacy to ensure every Marylander has an equal opportunity to achieve optimal health.

Licensed Social Work Care Coordinator will provide short-term care coordination services to individuals and families utilizing MD Medicaid insurance. The Social Work Care Coordinator will be responsible for receiving referrals from various sources, assessing client needs and partnering with Medicaid Managed Care Organizations, Providers, Public Health and community resources to address the needs identified as barriers to care. The SWCC also serves as a Team leader to provide best practice and interventions to resolve complex psychosocial and behavioral health conditions and needs.

• Participate in professional development opportunities that build effectiveness in areas of client engagement and intervention, motivational interviewing, trauma-informed outreach strategies.
• Participation in local/state meetings, conferences, community meetings.
• Participate in city-wide initiatives/groups/committees as applicable.
• Consistent and timely communication with supervisor- SW Program Manager
• Perform as a Team Lead responsible hosting team meetings with outreach staff members to discuss complex cases, best practices, and sharing of resources
• Community Partnerships/Outreach
• Initiate client outreach via telephone or via home visit within 5-10 days of receipt of a referral
• Outreach clients with medical or psychosocially complex needs. Assess and provide education of Medicaid benefits and services, re-connect recipients to medical home, Managed Care Organization, and link to covered benefits.
• Consult with other community agencies to identify potential resources for resolving social determinants of health needs
• Connect and collaborate with Providers, Hospitals, Community Based Organizations, MCO Case managers and other professionals to address and resolve client need

• Assess, triage, and refer clients to a variety of available resources to reduce barriers to wellness including the following partners: B’More for Healthy Babies Centralized Intake, home visiting, WIC, Safe Sleep, etc. Appropriate MCO incentive programs and case management, Medical Assistance Transportation
• Provide linkage and coordination to OB, MCO, pediatric or primary care, postpartum care, dental care, behavioral health, specialty care, as well as linkage to the Maryland Medical Care Programs as needed.
• Maintain a monthly minimum success rate of 70%.
• Maintain a monthly minimum on-time case closure rate of 90%.

• Documentation of all outreach activities according to standard operating procedures in the HCAM electronic medical database.
• Documents client assessments, activity, service plans and resolutions; prepare narrative and statistical reports.
• Provide Service Response letters to referring Entities at the time of case closure

• Complete and submit timesheets timely and accurately.
• Complete all the training courses required as assigned

• Additional duties as assigned

• Bachelor’s degree in a related area;
  Human Services, Social Work, Health Education, from an accredited college or university preferred but not required
• Community Health Worker Certification a plus; the willingness to undergo certification training within 1 year of employment
• A minimum of 3 years’ of related experience
• Relevant clinical experience providing services to pregnant women and/or infants, preferably in a public health/community setting

• Demonstrated knowledge in the following areas:
  Community Outreach and Medicaid System Navigation.
• Demonstrated knowledge and experience working with Health Choice Medicaid recipients and Managed…