JOB SUMMARY
The Outreach Specialist 1 conducts community outreach, health education and member support serving as a member advocate to Government Programs members and other products in designated counties. Duties include health education and benefit education by phone and face-to-face at member outreach events and health fairs, working with local, state and federal agencies on committees and workgroups that serve the member population.
ESSENTIAL FUNCTIONS OF THE ROLE
- Carries out community outreach contractual responsibilities for Government Programs, such as Medicaid, CHIP, Marketplace, and Medicare Advantage.
- Serves as Member Advocates to inform members of covered services, including preventive services, and non-capitated services (non-covered services) their rights and responsibilities, the complaint process and to assist members with writing or filing a complaint, or assisting through the appeals process until resolved.
- Conducts outreach to members at events in designated counties. Works with local, state and federal agencies on coalitions to educate on benefits, and community resources, including non-covered benefits or non-capitated resources. Prepares and delivers presentations to community, provider and member groups in a variety of settings.
- Provides face-to-face and telephonic member education on plan benefits, keeping eligibility and subsidy coverage without breaks in coverage, care coordination, and community resources.
- Partners with provider relations to educate key providers in the communities, such as Rural Health Clinics, Federally Qualified Health Care Centers (FQHCs) and other large Primary Care Providers (PCPs) that service members. Works with providers on coalitions, onsite member orientation, Texas Health Steps clinics and health fairs and in identifying Farmworker Children (FWC).
- Identifies, manages and reports on Farmworker children in designated counties. Documents activities with migrant organizations in a migrant documentation log. Attends quarterly migrant farmworker meetings.
- Participates in Member Advisory Group meetings, helps prepare agendas, minutes, and communicates incentives for member attendance.
- Responds to referrals for member education and outreach when issues are received from other divisions, the enrollment broker and the Health and Human Services Commission (HHSC). Assists Medicaid STAR members who have moved out of the area in reporting these changes, such as three-way calls to Health and Human Services Commission (HHSC) Office of Eligibility services to report changes.
- Participates in quarterly outreach staff meetings, and provides recommendations to leadership on identified care improvement opportunities.
- Coordinates with medical management as needed. Assists members with scheduling medical appointments and with transportation, including documentation in all relevant systems. Refers members with care coordination needs to case managers. Refers members with needs beyond care management to the Case Management for Children and Pregnant Women Program.
- Prepares reports, enters contacts and community activities into outreach systems, researches Texas Health Steps claims, and records checkup refusals, member contacts and other issues into core claims system.
$ads={1}
KEY SUCCESS FACTORS
- Community Health Worker (CHW) certification with the Department of State Health Services or willingness to receive certification within 90 days of hire.
- Working knowledge of government programs such as Medicaid, CHIP, Medicare or Marketplace.
- Proven oral and written presentation skills.
- Skilled in the use of computers and related software.
- Knowledge of managed care and medical terminology.
- Must be bilingual (English and Spanish)
- Skilled in exercising diplomacy in communicating with clients, patients, families and medical professionals.
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - Associate's or 2 years of work experience above the minimum qualification
- EXPERIENCE - 1 Year of Experience
$ads={2}
