Job description

Title: Community Health Coordinator

Location: Remote-DFW

Contract Duration: 6 months with possible extension

Target start date: 6/2023

ESSENTIAL FUNCTIONS:
Serve as the primary point of contact for members and community partners in assigned areas and perform ongoing functions to support the Social Service department and when designated the Physical and Behavioral health leads, including one or more of the following:

1. Create and submit member new authorizations to providers and monitor expiring member authorizations through reports for renewals.
2. Review authorization forms, processes, changes and document compliant within the specified turnaround time.
3. Monitor utilization of attendant services, including verification of new service start date with providers and over-utilization.
4. Performs claims remediation and review documents for MCO transfers involving authorizations and continuity of services when members transfer in or out of a MCO
5. Perform Social Service outreach and follow up attempts to members, including ER frequent fliers, and HRA questionnaire as requested. If tasked with face-to-face with members will encourage compliance with care plans and alert the Case Manager quickly when physical health and behavioral health issues arise.
6. Receive, analyze, conduct research and respond to telephone and/or written inquiries. Process information from member or provider to determine needs/wants and ensure customer questions have been addressed. Respond to customer or send to appropriate internal party.
7. Notify help desk of system issues.
8. Perform data entry function to update customer or provider information, especially regarding social service tasks and notes on services referred or unable to refer at this time.
9. Obtain required or missing information via correspondence or telephone.
10. In collaboration with the Health Education Coordinator, contribute to health literacy in assigned area as well as when requested in blitzes to promote a particular health prevention campaign
11. Serve as contact for the various groups regarding claims which involves conducting research, obtaining medical records/letters of medical necessity from TMG, reopen or initiate new cases as needed and refer case to clinicians.
12. Communicate and interact effectively and professionally with co-workers, management, customers, partnering agencies, etc.
13. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
14. Maintain complete confidentiality of company business.
15. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

JOB REQUIREMENTS:
 4+ years’ health, social services or community advocacy experience.
 Knowledge of medical terminology
 Experience coordinating member related needs, providing assistance to members, and analyzing member needs.
 PC proficiency including Microsoft Office applications.
 Customer service skills
 Verbal and written communications skills including developing written correspondence to members and to other department personnel and coaching skills, including motivational interviewing, to educate members on medical and BH issues.

PREFERRED JOB REQUIREMENTS:
 Community Health Worker (CHW) certification

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