Description:
Work Schedule/Shift & Time Zone:8am – 5pm CST
Is there potential for this to extend past 6 months and/or convert to an FTE?: Yes, potential for contract extension and/or convert to an FTE.
Candidate may be located anywhere within the approved 17 states
Must Have Requirements:
HS Diploma,
Experience with HEDIS
Care/Case Management experience preferred
Day to Day Responsibilities:
- The Managed Care Connector supports HEDIS and quality improvement initiatives by conducting member outreach and documenting engagement activities.
- This role involves working from assigned member spreadsheets to identify individuals with open care gaps and contacting members to encourage completion of preventive and recommended healthcare services.
Some responsibilities include:
- Conducting outbound calls to members to educate them on needed services and assist with overcoming barriers to care.
- Scheduling appointments with provider offices or connecting members with appropriate resources when needed.
- Accurately documenting all outreach attempts, member interactions, outcomes, and follow-up activities within the case management platform.
- Maintaining confidentiality and compliance with HIPAA and organizational policies.
- Collaborating with care management, provider, and quality teams to help improve member engagement and close gaps in care.
- This role serves as an important link between members and their healthcare providers, helping ensure members receive timely care while supporting the health plan’s quality and HEDIS performance goals.
POSITION OVERVIEW:
- Community Connectors works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential.
- Staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
ESSENTIAL POSITION RESPONSIBILITIES:
- Serves as a community based member advocate and resource, using knowledge of the community and resources available to engage and assist vulnerable members in managing their healthcare needs.
- Collaborates with and supports the Healthcare Services team by providing non-clinical paraprofessional duties in the field, to include meeting with members in their homes, nursing homes, shelters, or doctor’s offices, etc.
- Empowers members by helping them navigate and maximize their health plan benefits. Assistance may include: scheduling appointments with providers; arranging transportation for healthcare visits; getting prescriptions filled; and following up with members on missed appointments.
- Assists members in accessing social services such as community-based resources for housing, food, employment, etc.
- Provides outreach to locate and/or provide support for disconnected members with special needs.
- Conducts research with available data to locate members the company has been unable to contact (e.g., reviewing internal databases, contacting member providers or caregivers, or travel to last known address or community resource locations such as homeless shelters, etc.)
- Participates in ongoing or project-based activities that may require extensive member outreach (telephonically and/or face-to-face).
- Guides members to maintain Medicaid eligibility and with other financial resources as appropriate.
POSITION QUALIFICATIONS
- HS Diploma/GED
- Minimum 1 year experience working with underserved or special needs populations, with varied health, economic and educational circumstances