Role Description

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 assist 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.

• 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.
• 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.
• Collaborates with Case Management on the status of high-risk member referrals.
• Assists in finding and connecting members to community social services and agencies.
• 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.
• 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.
• 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.
• 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.
• Gain Subject Matter Expertise (SME) level in key focus area; develop training curriculum and facilitate workshop for team in conjunction with management team.

Qualifications

• 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.

Level II (in addition to Level I Minimum Qualifications)

• 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.

Requirements

• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• Ability to lift, carry, push, or pull 15 pounds or less.
• Reaching, crouching, stooping, kneeling required.
• 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.

Compensation

• Level I: N4: Minimum: $19.22 - Maximum: $30.76
• Level II: N5: Minimum: $20.02 - Maximum: $33.03

Benefits

• Participation in group health and/or dental insurance.
• Retirement plan.
• Wellness program.
• Paid time away from work.
• Paid holidays.