Community Connections Representative I/II (Rochester)

Univera Healthcare•Rochester, NY

3d•$19 - $33

About The Position

Summary: This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources and assists with navigating resources available and provide assistance with addressing SDoH barriers and care gaps. This position educates and assists with the enrollment and recertification process for Marketplace Facilitated Enrollment (MFE): On and Off Marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market - Qualified Health Plan (QHP). This position requires working occasional evenings and weekends for outreach and community events. Must be able to drive independently within the Health Plan regions Essential Accountabilities: Level I Educates Medicaid, Medicare, and Commercial members on healthcare benefits, and community resources through home visits and outreach. Educates and assists members with accessing care, Case Management program and benefits and government cell phone programs. Coordinates, plans and attends community events, including school events, health fairs and various community initiatives. Proactively informs and increases awareness of heath care offerings, state regulations and the Excellus/Univera brand/products at said events and within assigned territories. Completes scheduled and unscheduled home visits for noncompliance, gaps in care, community resource needs, and other high-risk issues. Conducts targeted phone calls for compliance, HEDIS initiatives and health risk assessments. Collaborate with Case Management on the status of high-risk member referrals. Assists in finding and connecting members to community social services and agencies. Enroll or refer qualified members in a health home. Communicates health insurance program options, fundamentals of all the health insurance products, benefits, and associated costs based on analysis of the applicant’s situation in Marketplace. Assists individuals and families with securing and providing required documentation to demonstrate age, residency, and income as is required by the Marketplace. Interprets a variety of complex instructions from the MFE Training Manual to assist applicants. Provides critical assessment and analysis which effects insurance enrollment for families and children. Presents all aspects of eligibility, enrollment and available products to community audiences. Meets with applicants in locations that have additional MFE resource backup. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs. 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 functions as assigned by management. Level II (in addition to Level I Essential Accountabilities) Manage the incoming Community Connections Referrals. Maintain the Community Resource Guide as needed. Ensure educational materials and supplies are replenished and available for use. Maintain the in-house Food Pantry ensuring all non-perishable items are within use by date. Works with management to participate in training process for new hires and team refreshers. Supervise Intern and/or mentor new hires to team; providing first level problem resolution, share Lifetime way cultural expectations, ensure successful on-boarding and engagement in role. Works with management on establishing influential relationships in the community within assigned territory. Attends community IPA/Navigator Agency as instructed. Represents the company in small/large community-based organization meetings as required/complement or collaboration with Community Engagement Program Manager. Gain Subject Matter Expertise (SME) level in key focus area; develop training curriculum and facilitate workshop for team in conjunction with management team.

Requirements

High school diploma or GED required. Associate degree preferred.
Minimum of two years of social services, community outreach, or education experience required.
Marketplace Facilitated Enroller certification preferred.
Demonstrated problem solving, interpersonal and communication skills.
Prior experience and working knowledge in Microsoft Suite including Excel and Word.
Minimum of two years’ experience working in the Community Connections Representative role.
Marketplace Facilitated Enroller certification required. Maintenance of certification through continuing education/training essential.
Demonstrated attention to detail.
Demonstrated leadership skills.
Demonstrated knowledge and experience of health care industry and Health Plan business.
Demonstrated ability to organize and represent an organization at community events preferred.
Highly effective communicator.
Must have a valid Class D license and ability to operate a motor vehicle.
The ability to hear, understand and speak clearly while using a phone, with or without a headset.

Responsibilities

Educates Medicaid, Medicare, and Commercial members on healthcare benefits, and community resources through home visits and outreach.
Educates and assists members with accessing care, Case Management program and benefits and government cell phone programs.
Coordinates, plans and attends community events, including school events, health fairs and various community initiatives. Proactively informs and increases awareness of heath care offerings, state regulations and the Excellus/Univera brand/products at said events and within assigned territories.
Completes scheduled and unscheduled home visits for noncompliance, gaps in care, community resource needs, and other high-risk issues.
Conducts targeted phone calls for compliance, HEDIS initiatives and health risk assessments.
Collaborate with Case Management on the status of high-risk member referrals.
Assists in finding and connecting members to community social services and agencies. Enroll or refer qualified members in a health home.
Communicates health insurance program options, fundamentals of all the health insurance products, benefits, and associated costs based on analysis of the applicant’s situation in Marketplace.
Assists individuals and families with securing and providing required documentation to demonstrate age, residency, and income as is required by the Marketplace.
Interprets a variety of complex instructions from the MFE Training Manual to assist applicants. Provides critical assessment and analysis which effects insurance enrollment for families and children. Presents all aspects of eligibility, enrollment and available products to community audiences.
Meets with applicants in locations that have additional MFE resource backup.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
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 functions as assigned by management.
Manage the incoming Community Connections Referrals.
Maintain the Community Resource Guide as needed.
Ensure educational materials and supplies are replenished and available for use.
Maintain the in-house Food Pantry ensuring all non-perishable items are within use by date.
Works with management to participate in training process for new hires and team refreshers. Supervise Intern and/or mentor new hires to team; providing first level problem resolution, share Lifetime way cultural expectations, ensure successful on-boarding and engagement in role.
Works with management on establishing influential relationships in the community within assigned territory.
Attends community IPA/Navigator Agency as instructed.
Represents the company in small/large community-based organization meetings as required/complement or collaboration with Community Engagement Program Manager.
Gain Subject Matter Expertise (SME) level in key focus area; develop training curriculum and facilitate workshop for team in conjunction with management team.