Company :Highmark Inc.Job Description :JOB SUMMARYThis job serves as a liaison and mediator between members, providers, community centers, and the Organization. Works independently in the community engaging members within a specific target population as defined by the Plan. Works face-to-face with members to provide basic health literacy, linkage to community resources, and assistance navigating the healthcare system and brings education and support to members in the community and serves as a healthcare advocate for members. The goal is to outreach and engage members to improve health outcomes, close care gaps and improve overall wellness by connecting members to providers and community resources and develop partnerships with community centers and local community based resources to support the needs of the members as well as the community. The incumbent works closely with the care management department to refer members for additional support and education beyond the job's scope of practice.ESSENTIAL RESPONSIBILITIES
Initiate outreach efforts, face-to-face, related to targeted preventive health, maternity, care transitions and chronic condition initiatives.
Educate member(s) on the importance of targeted preventive health services, assess opportunity for care management intervention and make appropriate referrals, including referrals to the Behavioral Health Managed Care Organization (BHMCO) as needed. Contact member(s), providers and community agencies to coordinate access to preventive health services.
Develop a rapport with members and community centers to establish a supportive relationship which empowers members to take an active role in their health and wellness.
Assist members with completing a Health Risk Assessment, identifies/providing direction to managing healthcare barriers (i.e. knowledge deficit, transportation, financial), scheduling appointments, and answering questions.
Collaborate with human services providers such as Head Start Programs, WIC, community centers, and homeless shelters; as well as state agencies such as Children and Youth Services (CYS) and juvenile probation in the identification and outreach to members in need of services.
Understand the Organization's lines of business and benefits for members in order to provide accurate and current information to member in the community.
Contribute to the development and preparation of educational materials for members and providers.
Conduct provider and community training on Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services and other special preventive health initiatives.
Provide summary and outcomes of training 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.
Represent the company at community events, including events sponsored by community centers.
Other duties as assigned or requested.
EDUCATIONMinimum
High School Diploma/GED
Substitutions
None
Preferred
None
EXPERIENCEMinimum
WV Clearances:700.1 (Child Abuse & State Police clearance )700.2 (Fingerprints & Federal background clearance) Chapter 700 WV clearance for access: Registry and employment screening (WV CARES )
Preferred
Experience in a health care related customer service or marketing environment that would demonstrate the ability to positively impact the engagement of members in the organization's condition and case management programs
Bilingual, Spanish speaking
Basic medical terminology background
Experience with the targeted community or population
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, child care, 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
LICENSES AND CERTIFICATIONSRequired
None
Preferred
None
TRAVEL REQUIREMENT50% - 75%LANGUAGE REQUIREMENT ( other than English )?NonePHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONSPosition TypeMost On-The-RoadTeaches/Trains others regularlyRarelyTravels regularly from the office to various work sites or from site-to-siteFrequentlyWorks primarily out-of-the office selling products/services (Sales employees)Does Not ApplyPhysical Work Site RequiredNoLifting: up to 10 poundsConstantlyLifting: 10 to 25 poundsOccasionallyLifting: 25 to 50 poundsNeverDisclaimer: 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 position 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:$20.31Pay Range Maximum:$29.53Base 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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migratedfiles/employers/posterscreenreaderoptimized.pdf )We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.orgCalifornia Consumer Privacy Act Employees, Contractors, and Applicants NoticeReq ID: J247701