This position acts as a program liaison with physician offices, community agencies, and hospitals to promote care management programs. Acts as a member advocate by addressing barriers to care and educates appropriate use of services. Promotes programs and services available to the uninsured.
• Explores multiple sources of information to identify at-risk members who would benefit from Safety Net Care Management.
• Assesses member’s needs by applying Health Plan approved guidelines and assessment tools. Makes appropriate referrals to clinical programs.
• Provides education for members on health care benefits and responsibilities. (i.e. access to care, preventive health, and chronic diseases).
• Establishes networking relationships with community agencies providing services to members. Provides advocacy for members and their support systems, encourages self-sufficiency by effective teaching and mentoring. (i.e. transportation, housing, primary care physician and cultural barriers).
• Coordinates, presents, and promotes clinical programs to provider offices, group seminars, hospitals, home care, and community agencies. Educates providers and community agencies on information regarding services and programs available to the uninsured.
• Interacts with diverse members, professionally communicates with physicians, manages a caseload productively, and keep appropriate documentation according to health plan standards.
• Meets or exceeds established departmental metrics.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other duties as assigned by management.
Associates degree in human services or business related field. Bachelor’s degree (or higher) is preferred. A minimum of three (3) years experience in health/human services. Experience with project management. Experience with working with low-income diverse population. Experience with giving formal/informal presentations to small/large audiences. Knowledge of preventive health activities and community agencies preferred. Proficiency in MS Office programs (Word, Excel, PowerPoint). Self-motivated and able to work independently as well as on an intra/inter-departmental teams. Ability to problem solve for effective conflict resolution. Physical Requirements Travel requires approximately 75% to various counties; community agencies, office locations, and may encounter physical obstacles. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer
Excellus BlueCross BlueShield - 9 months ago