The Integrated Model for D-SNP team is focused on delivering an integrated member experience through a multidisciplinary team. Focused on the highest risk D-SNP members, this team coordinates both inbound and outbound customer and clinical service interactions. This is a unique opportunity to provide direct member care and help evolve the care model based on insights.

We are looking for an individual who is:

• Passionate about transforming our healthcare system to meet members’ rapidly evolving complex needs
• Dedicated to serving at risk populations most in need of additional supports
• Enthusiastic about working in an agile and fast-paced environment

Responsibilities

Research indicates that insecurity of one’s basic needs including housing, food, income, and transportation has a direct impact on overall health and wellbeing. Working within an interdisciplinary care team including a Clinical Social Worker, Registered Nurse, Clinical Pharmacist, and a Care Coordinator, the Care Coach (Community Health Worker) is responsible for addressing gaps in members’ resources and supports in correlation with Social Determinants of Health and implementing targeted referrals.

The Care Coach (Community Health Worker) forms authentic alliances with members that will serve as the catalysts for uncovering what is getting in the way of the members achieving better health outcomes, and actively works to find resources.

This role requires an understanding of how socioeconomic stressors can impact ability to engage in healthcare and subsequent health outcomes. Experience should include prior work with patients with behavioral health diagnoses, as well as in navigating local community-based resources and supports.

This is a remote position.

Major Duties and Responsibilities

• Determine members’ scopes of need as related to Social Determinants of Health

• Identify existing barriers to engagement with necessary resources and supports

• Provide education to members around maintenance of chronic health conditions as well as available options for behavioral care and social support

• Serve as liaison between the member and the direct care providers, assisting the member in navigating both internal and external systems

• Supporting members’ self-determination, motivate members to meet the health goals they have identified

• Refer member to necessary services and supports

  • This field may include but is not limited to: assistance with transportation, food insecurity, navigation of financial benefits, obtaining necessary prescription medications, organizing schedules of follow up appointments, alleviating social isolation

• Utilize digital software to initiate referrals to community-based organizations and track their progress

• Schedule follow up phone calls to determine referral success and maintain rapport

• Perform all other duties and responsibilities as required

Organizational Responsibilities

• Participate in group meetings with other Community Health Workers, and direct supervision with the Community Health Supervisor

• Maintain patient confidentiality in accordance with HIPAA

• Demonstrate a desire and commitment to meeting member’s needs as well as improving their overall experience of interactions with the team

• Document patient encounters in medical record system in a timely manner

• Follow general policies related to fire safety, infection control and attendance

Required Qualifications

• Bachelor’s Degree in Human Services related field

• Minimum of 2 years of experience working in the community and navigating community-based resources

Preferred Qualifications

• Familiarity with hCAT/CGX and or Salesforce CRM

• Experience working with Medicare and dual-eligible members

• Experience working with an interdisciplinary team

Skills/Abilities/Competencies Required

• Ability to multi-task in a fast-paced work environment

• Flexibility to fluidly transition and adjust in an evolving role

• Excellent organizational skills

• Advanced oral and written communication skills

• Strong interpersonal and relationship building skills

• Compassion and desire to advocate for patient needs

• Critical thinking and problem-solving capabilities

• Excellent verbal, listening and written communication skills

• Aptitude for quickly learning and navigating new technology, systems and applications

Working Conditions

This position is remote.

Additional Information

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Scheduled Weekly Hours

40