Community Health Worker - Medicaid

Job Summary

This job serves as a liaison and mediator between members, providers, community
-based organizations, and the health plan. Works independently in the community, engaging members within a specific target population as determined by the Managed Care Organization. Works face-to-face and telephonically with members to provide basic health literacy, linkage to community resources, and assistance navigating the healthcare system. The Community Health Worker brings education and support to members in the community and serves as a healthcare advocate for members.

This role will outreach and engage members to improve health outcomes, close care gaps and improve overall wellness. Community Health Workers will develop partnerships with local community based organizations and providers to support the needs of the members as well as the community. The incumbent works closely with the care management department and other internal team members to refer members for additional support and education beyond this role’s scope of practice.

• Initiate outreach efforts, both face-to-face and telephonically, related to targeted preventive health, care gaps, maternity, care transitions, health related social needs and chronic condition initiatives.
• Educate members on the importance of targeted preventive health services, assess opportunities for care management intervention, and make appropriate referrals, including referrals to community resources as needed.
• Contact member(s), providers, and community agencies to coordinate access to preventive health services and/or assistance to address health-related social needs.
• Develop a rapport with members, community-based organizations and provider partners to establish a supportive relationship which empowers members to take an active role in their health and wellness.
• Collaborate with human services providers such as Head Start Programs, WIC, community centers, and homeless shelters, in the identification and outreach to members in need of services.
• Contribute to the development and preparation of educational materials for members and providers.
• Provide summary and outcomes of outreach attempts and community education 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.
• Conduct SDOH assessments as needed and assist with scheduling appointments, addressing social health barriers, and answering questions.
• Understand the Organization's lines of business and benefits for members in order to provide accurate and current information to member.
• Represent the company at community events, including events sponsored by community partners.
• Other duties as assigned or requested.

• Required:
  
  1 year of experience in a health care related customer service or marketing environment that would demonstrate the ability to positively impact on the engagement of members in the organization's condition and case management programs.
• Required:
  
  1 year of Community Health Worker experience or related field.
• Preferred:
  Basic medical terminology background.
• Preferred:
  Experience with the targeted community or population.

• Knowledge of principles and processes for providing customer service.
• This includes customer needs assessment, meeting quality standards for services.
• 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.
• Ha…