Community Health Worker - Medicaid

Company :

Job Description : 

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.

ESSENTIAL RESPONSIBILITIES

• 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. 

EXPERIENCE

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

• 1 year of Community Health Worker experience or related field

Preferred

• Basic medical terminology background

• Experience with the targeted community or population

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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, childcare, 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

EDUCATION

Required

• High School/GED

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• Certified Community Health Worker (CCHW) - PA Certification Board within 12 months of start date.

Preferred

• None

Language (Other than English):

• None

Travel Required:

• 50% - 75%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

• Office-Based or Remote Position

Physical work site required

• 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 job 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.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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