Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

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Administrative & Support
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ConnectiCare
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Community Health Workers - Field Based Regional opportunities located in areas of:
Bridgeport
Hartford
Waterbury/Torrington
Meriden
New Haven
Norwich/Putnam

 

Summary of Job:  Responsible for the execution of the non-clinical aspects of the Care Management process.  Supports the implementation of the clinical care plan in conjunction with the Clinical team.  Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations, request clinical information, perform case research, and essentially execute all behind the scenes desk-level procedures of a case. Work seamlessly with the Care Specialists, Care Managers and Social Workers (and other clinical staff) to ensure everything that a participant needs to tend to their health is addressed. Provide confidential administrative support and assistance to the department and support the department in all aspects of daily project operations. Assist the entire Care Management interdisciplinary team in managing members with Care Management needs. Provide telephonic and in-person outreach to members that have been identified for care management and ensure members’ needs are supported throughout the duration of member enrollment to the program, by completing screenings with members, coordinating with Care Manager on members’ care plan, making appropriate referrals to tthe interdisciplinary care team, coordinating post-acute services on behalf of members, assisting with community resource needs and more. Perform in-person member visits in community settings, such as their home, CONNECTICARE Retail Centers, Neighborhood Care Centers, Community Agencies, hospitals and physician offices to introduce care management programs and validate member contact information.

Responsibilities

  • Work collaboratively, as a critical component of the Medical Management team, to facilitate all clerical and administrative processes and activities.
  • Perform accurate and timely intake and data entry for all Care Management requests and referrals for all lines of business, upon receipt of inbound requests, via call, fax and web portal, in accordance with departmental policy and regulatory requirements.  
  • Perform member telephonic and in-person outreach for program enrollment with the goal of retaining members in the Care Management Program.
  • Perform in-person member visits in community settings, such as their home, CONNECTICARE Retail Centers, Neighborhood Care Centers, Community Agencies, hospitals and physician offices to introduce care management programs and validate member contact information.
  • Triage cases and assign receipts to appropriate teams.
  • Communicate and/or respond to inquiries from providers, facilities and members. 
  • Initiate completion of member and provider correspondence and verbal outreach according to departmental guidelines.
  • Enter and maintain documentation in electronic record, meeting defined timeframes and performance standards.
  • Provide phone queue management for both incoming and outgoing calls.
  • Perform other related projects and duties as assigned.
  • Under the direction of a Care Manager, manage caseload and update care plans for low and moderate risk members in collaboration with the clinical team.
  • Support care interventions including making doctor’s appointments, health coaching, referrals to internal and external resources, assist with transportation issues.
  • Identify and address support needs for Transitions of Care.
  • Leverage motivational interviewing skills and a member-centric approach to identify members’ needs, prioritize and support care plan.
  • Perform a wide range of research and educational outreach activities to encourage healthy behaviors, such as outreaching to identified members who need a primary care provider or who may have gaps in care related to recommended tests or provider visits and facilitate gap closure and receipt of evidence-based care.
  • Adhere to processes for collecting member-specific clinical and demographic data from providers and other entities as required by clinical staff.
  • Support communication and coordination with delegated entities, as necessary.
  • Coordinate directly with community-based organizations and agencies to identify available and/or alternative resources for a wide range of concerns, including home safety, financial assistance, caregiver support and transition assistance.
  • Actively participate in assigned committees and projects.
  • Additional tasks and duties as required.

 

Qualifications

  • High School Diploma required; 
  • Associate Degree or Medical Assistant certification preferred; Bachelor’s in related field preferred.
  • Community Health Worker Certification or equivalent work experience. CHW certification required within 2 years of employment.
  • 2 -3 years’ relevant professional work experience required; Additional years of experience/certifications/training may be considered in lieu of educational requirements.
  • Experience working in a multicultural setting required preferred.
  • Familiarity with local community, neighborhood, boroughs in which you would be assigned preferred.
  • Fluency (verbal) in English and Spanish preferred.
  • Excellent customer service skills required.
  • Verifiable good driving record and a reliable source of transportation required.
  • Strong oral, written and interpersonal communication skills required.
  • Ability to work both independently and collaboratively with others.
  • Previous system user experience in a highly electronic environment required.
  • Proficiency in Microsoft Office suite skills required.
  • Knowledge of medical terminology and medical payment preferred.
  • Ability to prioritize multiple tasks.
  • Required to work weekends and holiday as necessary.
  • Ability to travel to client-based locations.
  • Detailed oriented; strong organizational and prioritization skills required.
  • Dedicated home office space with reliable internet access to ensure PHI HIPPA compliance required.
  • Strong problem-solving ability and Flexibility required.

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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