Health Care Guide

Overview

In collaboration with Care Coordination team members, this position provides support and guidance to Health Plan members referred to the Care Coordination Department for Case Management services and programs. The Health Care Guide I works closely with members, families, providers, community agencies, and the interdisciplinary care team to assist in coordination of benefits in a timely and cost-effective manner, while connecting members to available internal and external resources.

• Acts as the point of contact for members, families, providers, and/or community agencies calling into the Care Coordination Department requesting assistance and information about available Partnership programs and information.
• With direction, initiates and processes referrals to appropriate programs in accordance with department policies, and communicates referral outcomes to referral source.
• Collaborates with members, families, providers, and/or community agencies to identify member needs and/or barriers.
• Conducts targeted assessments to identify care coordination needs.
• Researches appropriate and available Partnership and/or community resources and provides guidance to member and interdisciplinary care team.
• Creatively utilizes available resources in the most cost-effective manner in collaboration with the Case Manager.
• Assists members to ensure timely access to providers and services.
• Initiates and processes referrals to appropriate programs in accordance with department policies, and communicates referral outcomes to referral source.
• Completes timely and accurate documentation in appropriate systems in accordance with department policies.
• Supports the Care Coordination Department by answering the ACD telephone line, determining call urgency and routing calls appropriately.
• Provides excellent customer service and communicates with others in accordance with Partnership standards and expectations.
• Exhibits high professional standards as outlined in Partnership’s Code of Conduct.
• Communicates clearly and effectively through all mediums of communication with members, providers, vendors, community partners, and Partnership employees.
• Responds to inquiries in a timely.
• Connects members to community agencies when necessary.

• Obtains records and information as requested by clinical.
• Provides support and assistance to clinical staff as needed.
• Collaborates with internal Partnership departments to resolve issues.
• Attends required meetings and trainings in person when assigned.
• Provides periodic coverage during vacations or sick time for Health Care Guide staff as needed within assigned team.
• Performs other duties as assigned by the direct supervisor, including the assumption of new duties.

Education and Experience

High school diploma or equivalent combination of experience and education required; associate’s or bachelor’s degree preferred. Two (2) years of experience working in a health care setting recommended, to include experience in case management or care coordination; or any work experience, training or specialized education that would likely provide the ability to perform the essential functions of the position. Preference may be given to individuals certified and/or licensed in a health related field.

Special Skills, Licences and Certifications

Ability to use good judgment, take personal initiative, and use discretion in performing job responsibilities. Attention to detail and accuracy. Basic knowledge of medical terminology and coding. Ability to listen actively and practice motivational interviewing. Knowledge of the Partnership and basic concepts of managed care. Ability to learn the following: case management role within a health plan setting, and the Health Plan eligibility categories.

Ability to use computer software for word processing, spreadsheets, and email, operating multiple computer programs simultaneously. Ability to function effectively with frequent interruptions and direction from multiple team members. Ability to work in an environment with diverse individuals and groups. Ability to establish collaborative relationships. Ability to work…