Community Health Worker-Telephonic

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Community Health Worker is responsible for assessment, planning and implementing care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care. They also Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services, and manage the care plan throughout the continuum of care as a single point of contact for the member. The coordinator also addresses social determinant of health such as transportation, housing, and food access; link to community supports.

Working Schedule: Monday through Friday, 8:00am to 5:00pm CST

If you reside in the state of Texas, you’ll enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Create a positive experience and relationship with the member
• Proactively engage the member to manage their own health and healthcare
• Support the member to improve their wellbeing by staying out of the hospital, and attend regular visits to their primary physician
• As needed, help the member engage with mental health and substance use treatment
• Provide member education on community resources and benefits
• Conduct post discharge activities from hospital facility and support connection to social services
• Partner with care team (community, providers, internal staff)
• Knowledge and continued learning of community cultures and values
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Answer incoming phone calls from health care providers (i.e. physician offices, clinics) and identify the type of assistance the provider needs (EG)
• benefit and eligibility, billing and payments, authorizations for treatment, explanation of benefits)
• Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller
• Deliver information and answer questions in a positive manner to facilitate strong relationships with providers and their staff
• Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends
• Extensive work experience with Medicaid community
• Monitor timely receipt, accuracy and compliance of State assessments. Maintain 100% adherence to State contract, CMS requirements, and UnitedHealthcare Community Plan Performance and Quality metrics around Conversion Goals. 100% adherence to submission timelines of scheduled department reports, assigned metrics and state deliverables.100% adherence to submission deadlines on complaints
• Meet State Partner and Internal expectation on timeliness & quality of interactions with members and providers
• Demonstrate compliance in the urgency of all Star+Plus State & internal deadlines
• Act as an advocate for membership and establish effective working relationships with our providers to service our members, ensuring all federal, state and company regulations, policies, and expectations are followed
• Be responsive to our members (retention & referrals) and providers (contracting retention)
• Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and/or providers
• All other duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma/GED (or higher)
• 2+ years of clerical or administrative experience
• Intermediate level of computer proficiency (including Microsoft Outlook, Teams) and ability to use multiple web applications
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
• Ability to travel up to 10% of the time for team meetings or company events

Preferred Qualifications:

• Associate degree (or higher) in a health-related field
• Certified Nursing Assistant/Home Health Aide, Certified Medical Assistant
• 1+ years of knowledge of the resources available, culture, and values in the community
• Community Health Worker (CHW) Accreditation
• Experience working in managed care
• Knowledge of Medicaid/Medicare population
• Working knowledge of medical terminology
• Bilingual Spanish/English

• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO, #Green