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About the Role

This position assists the Health Plan in establishing a community presence through home visits and outreach, bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members on accessing community resources, assist with navigating available resources, and provide assistance with addressing Social Determinants of Health (SDoH) barriers and care gaps. This role also educates and assists with the enrollment and recertification process for various health insurance products.

Responsibilities

• Educates members on healthcare benefits and community resources through home visits and outreach.
• Educates and assists members with accessing care, Case Management programs, benefits, and government cell phone programs.
• Coordinates, plans, and attends community events, including school events, health fairs, and community initiatives.
• Informs and increases awareness of health care offerings, state regulations, and the Excellus/Univera brand/products at 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.
• Collaborates with Case Management on the status of high-risk member referrals.
• Assists in finding and connecting members to community social services and agencies.
• Enrolls or refers qualified members in a health home.
• Communicates health insurance program options, product fundamentals, benefits, and associated costs based on applicant situations.
• Assists individuals and families with securing and providing required documentation for age, residency, and income verification.
• Interprets complex instructions from the MFE Training Manual to assist applicants.
• Provides critical assessment and analysis affecting insurance enrollment for families and children.
• Presents eligibility, enrollment, and available product information to community audiences.
• Meets with applicants in locations with additional MFE resource backup.
• Demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values.
• Maintains high regard for member privacy in accordance with corporate privacy policies and procedures.
• Manages incoming Community Connections Referrals (Level II).
• Maintains the Community Resource Guide (Level II).
• Ensures educational materials and supplies are replenished (Level II).
• Maintains the in-house Food Pantry (Level II).
• Participates in training for new hires and team refreshers (Level II).
• Supervises interns and/or mentors new hires (Level II).
• Establishes influential relationships in the community (Level II).
• Attends community IPA/Navigator Agency meetings as instructed (Level II).
• Represents the company in community-based organization meetings (Level II).
• Gains Subject Matter Expertise (SME) in key focus areas (Level II).
• Develops training curriculum and facilitates workshops (Level II).

Requirements

• High school diploma or GED required.
• Minimum of two years of social services, community outreach, or education experience required.
• 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 (Level II).
• Maintenance of Marketplace Facilitated Enroller certification through continuing education/training is essential (Level II).
• Demonstrated attention to detail (Level II).
• Demonstrated leadership skills (Level II).
• Demonstrated knowledge and experience of the health care industry and Health Plan business (Level II).
• Demonstrated ability to organize and represent an organization at community events preferred (Level II).
• Highly effective communicator (Level II).
• Ability to work in a home office for continuous periods of time.
• 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.
• Ability to hear, understand, and speak clearly while using a phone.

Skills

• Microsoft Suite (Excel, Word)
• Problem-solving
• Interpersonal communication
• Communication
• Attention to detail
• Leadership
• Health care industry knowledge
• Health Plan business knowledge
• Organization
• Community event representation
• Effective communication

Location

• Health Plan service region

Work Type

• Occasional evenings and weekends
• Home office
• Travel required
• Remote work possible

Experience Level

• Level I
• Level II

Education Level

• High school diploma or GED
• Associate degree preferred
• Marketplace Facilitated Enroller certification preferred (Level I)
• Marketplace Facilitated Enroller certification required (Level II)

Salary/Compensations

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

Benefits

• Group health and/or dental insurance
• Retirement plan
• Wellness program
• Paid time away from work
• Paid holidays

About the Company

• The Lifetime Healthcare Companies

Equal Opportunity

• All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.