Community Health Worker - Remote Houston, TX

United Healthcare is simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts millions of lives for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable.

Community Health Worker is responsible for assessment, planning and implementing individualized care strategies directed toward the most appropriate, least restrictive level of care. They identify and initiate referrals for social service programs, manage the care plan throughout the continuum of care as a single point of contact for the member, and address social determinants of health such as transportation, housing and food access.

• Create a positive experience and relationship with the members
• Proactively engage the members to manage their own health and healthcare
• Support the members to improve their wellbeing by staying out of the hospital and attending regular visits to their primary physician
• As needed, help the member engage with mental health and substance use treatment
• Provide member education on community resources and benefits
• Partner with the care team (community, providers, internal staff)
• Knowledge and continued learning of community cultures and values
• Communicate with all stakeholders the required health‑related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Answer incoming phone calls from health care providers (i.e., physician offices, clinics) and identify the type of assistance the provider needs (benefit and eligibility, billing and payments, authorizations for treatment, explanation of benefits)
• Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller
• Deliver information and answer questions in a positive manner to facilitate strong relationships with providers and their staff
• Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends
• Extensive work experience with Medicaid community
• Monitor timely receipt, accuracy and compliance of State assessments. Maintain 100% adherence to State contract, CMS requirements, and United Healthcare Community Plan Performance and Quality metrics around Conversion Goals. 100% adherence to submission timelines of scheduled department reports, assigned metrics and state deliverables. 100% adherence to submission deadlines on complaints
• Meet State Partner and Internal expectation on timeliness & quality of interactions with members and providers
• Demonstrate compliance with the urgency of all Star+Plus State & internal deadlines
• Act as an advocate for membership and establish effective working relationships with our providers to service our members, ensuring all federal, state and company regulations, policies, and expectations are followed
• Be responsive to our members (retention & referrals) and providers (contracting retention)
• Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers
• All other duties as assigned

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life & AD&D Insurance along with Short‑term disability and Long‑term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: (Use the "Apply for this Job" box below)./uhgbenefits

• High School Diploma/GED (or higher)
• 2+ years of experience working within the community health setting in a healthcare role
• Intermediate level of computer proficiency (including Microsoft Outlook, Teams) and…