Position Purpose:
Supports community connection activities including connecting members to community resources to support their care management journey and provide necessary care resources in a cost-effective manner. Provides members with known community resources and supports the care team to identify member community support and provide health education as appropriate.
Education/Experience:
Requires a High School diploma or GED
Requires 1 2 years of related experience
Provides support to members to connect them to known community and care resources in a cost- effective manner
Supports the coordination of community outreach resources available to members and promotes awareness of care/services
Serves as support for members on community and care resource inquiries and opportunities available to members
Supports all member related correspondence and educational materials to assist in the facilitation of a successful community connection
Documents and maintains all community resources to ensure standards of practice and policies are in accordance with health plan requirements
Provide assistance to the clinical team of nurses and social workers. Activities include, but are not limited to outreach, community education, informal guidance and member support
Conduct non-clinical general health assessments in order to refer members to appropriate care/services, resolve concerns on member s behalf, and gather information for medical providers and staff working within the organization
Conduct non-medical assessments such as home safety, assessment of the community/environment resources, transportation, employment, and others to be able to refer to appropriate care/services, resolve concerns on member s behalf, and gather information for medical providers in staff working within our organization
Conduct telephonic and/or in-person outreach to locate individuals and families in the community who are hard to reach
May make visits to individual homes and/or community organizations
Working Knowledge of Social Determinants of Health (SDOH) barriers
Performs other duties as assigned
Complies with all policies and standards
MINIMUM QUALIFICATIONS
Education and Experience
" Requires a High School diploma or GED
" Requires 1 2 years of related experience
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| Story Behind the Need |
- What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
| - The purpose of our team is to reduce readmissions, potentially preventable events at the emergency room, ensure members are connected to transportation and ancillary services as needed for medical care or social needs, work with parents/providers or children with elevated blood lead levels to identify source of lead and help blood lead levels trend downward, coordinate with LPHAs for treatment of any member suspected with tuberculosis, and partner with rural medical hubs for the state s Transformation of Rural Community Health program.
- New projects and staff fluctuations (Centene reorganization and a few people on different kinds of LOAs on the team)
- Our team is responsible for inpatient, post discharge, and emergency department diversion outreach. We also have a dedicated team that works with non-emergency medical transportation requests. Our team also outreaches providers and parents of children with elevated blood lead levels or members with suspected tuberculosis diagnosis with the purpose of coordinating with their local public health departments and state partners. Our team also delivers high need items to pregnant/postpartum members in the community in the STL city/county area. The team works in pods. Many are cross trained across projects. The team is very communicative with one another and always willing to jump in and help their peers.
- No upcoming hiring needs at this time
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| Typical Day in the Role |
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
| - Login to phone system to take inbound calls, review non-emergency medical transportation requests (verify appointments, outreach member, review claims, etc.) and approve/deny then send back to requestor, escalate any concerns to people leader, outreach members from daily report assignments for emergency department diversion, attend required meetings/trainings
- 20-25 calls per day (inbound/outbound), answer inbound calls within 28 seconds (with less than 3% of calls abandoned), 95% on documentation/phone audits, 30% success rate with phone calls, ensuring phone application aux codes appropriately, adhere to department policy and procedures, must have working internet (preferably high speed but at least 30 Mbps for download)
- What makes the Community Resource Coordinator role unique is its integration of care coordination, public health, and community partnership efforts, proactively addressing medical, behavioral, social, and environmental barriers to care through initiatives that reduce preventable emergency department, support transportation and social needs, and connect members to innovative rural health resources and community-based services.
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