Community Health Worker - Remote in Bexar & Harris County, Texas

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.

As a Support Service Coordinator (SSC), you will act in a liaison role with Medicaid members to ensure appropriate care is accessed as well as to provide home and social assessments and member education. SSC's work in a team - based structure and spend most of their time engaging directly with members. Interesting in learning to work with medically complex patients who may be experiencing significant health conditions is important for this role. Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services. Manage the care plan throughout the continuum of care as a single point of contact.

Schedule: This position is full - time (40 hours / week) Monday - Friday. Employees are required to work our 8 - hour shift schedules during our normal business hours of 8:00am to 5:00pm. It may be necessary, given the business need, to work occasional overtime. This position is a based position with a home - based office.

If you are located in Harris County or Bexar County, TX or surrounding areas you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Create a positive experience and relationship with the members
• Help members set goals and develop a care plan to achieve those goals
• Proactively engage the members to manage their own health and healthcare
• Support the members 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
• Support the member to ensure pick-up of their prescriptions
• Provide member education on community resources and benefits
• Conduct post discharge activities from hospital facility and support connection to social services
• Support members to engage in work or volunteer activities, if desired, and develop stronger social support through deeper connections with friends, family, and their community
• Partner with care team (community, providers, internal staff)
• Knowledge and continued learning of community cultures and values
• Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services
• Manage the care plan throughout the continuum of care as a single point of contact
• 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 with 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)
• Manage administrative intake of members
• Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers
• Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
• Receive care coordination notification cases for non-clinical assessment/intervention and provide appropriate triage
• Review requests for adverse determination, approval notification and processing notification requirements
• Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review

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)
• 3+ years of experience working within the community health setting in a health care role
• Intermediate level of proficiency with MS Word, Excel (create, edit, save documents) and Outlook (email and calendar management) and the 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)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

• Community Health Worker (CHW) Accreditation
• Experience working in Managed Care
• Knowledge of Medicaid/Medicare population

Soft Skills:

• Prioritizes and organizes own work to meet agreed upon deadlines
• Works with others as part of a team
• Solves routine problems on own - Works with supervisor to solve more complex problems
• Strong communication and customer service skills both in person and via phone
• Ability to work independently and maintain good judgment and accountability
• Demonstrated ability to work well with others
• Strong organizational and time management skills
• Ability to multi-task and prioritize tasks to meet all deadlines
• Ability to work well under pressure in a fast-paced environment
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

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