Community Connections Representative I​/II; Buffalo and Rochester

Community Connections Representative I/II (Buffalo and Rochester)

This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources and assist with navigating resources available and provide assistance with addressing SDoH barriers and care gaps. This position educates and assists with the enrollment and recertification process for Marketplace Facilitated Enrollment (MFE) – On and Off Marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market – Qualified Health Plan (QHP).

This position requires working occasional evenings and weekends for outreach and community events.

• Educates Medicaid, Medicare, and Commercial members on healthcare benefits, and community resources through home visits and outreach.
• Educates and assists members with accessing care, Case Management program and benefits and government cell phone programs.
• Coordinates, plans and attends community events, including school events, health fairs and various community initiatives; proactively informs and increases awareness of healthcare offerings, state regulations and the Excellus/Univera brand/products at said 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, fundamentals of all the health insurance products, benefits, and associated costs based on analysis of the applicant’s situation in Marketplace.
• Assists individuals and families with securing and providing required documentation to demonstrate age, residency, and income as required by the Marketplace.
• Interprets a variety of complex instructions from the MFE Training Manual to assist applicants; provides critical assessment and analysis which affects insurance enrollment for families and children; presents all aspects of eligibility, enrollment and available products to community audiences.
• Meets with applicants in locations that have additional MFE resource backup.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

• Manages the incoming Community Connections Referrals.
• Maintains the Community Resource Guide as needed.
• Ensures educational materials and supplies are replenished and available for use.
• Maintains the in-house Food Pantry ensuring all non-perishable items are within use by date.
• Works with management to participate in training process for new hires and team refreshers; supervises Intern and/or mentors new hires to team; providing first level problem resolution, sharing Lifetime way cultural expectations, ensuring successful onboarding and engagement in role.
• Works with management on establishing influential relationships in the community within assigned territory.
• Attends community IPA/Navigator Agency as instructed.
• Represents the company in small/large community-based organization meetings as required/complement or collaboration with Community Engagement Program Manager.
• Gains Subject Matter Expertise (SME) level in key focus area; develops training curriculum and facilitates workshop for team in conjunction with management…