
Bilingual English / Spanish Community Health Worker
- El Paso, TX
- $20.00-35.72 per hour
- Permanent
- Full-time
- Assess, plan, and implement care strategies that are individualized for each member and directed toward the most appropriate, lease restrictive level of care
- Utilize both company and community-based resources to establish a safe and effective case management plan for members
- Collaborate with member, family, and healthcare providers to develop an individualized plan of care
- Identify and initiate referrals for social service programs, including financial, psychosocial, community, and state supportive services
- Manage 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 healthcare team
- Understand insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan
- Monitor services being delivered to ensure timeliness, appropriateness, and satisfaction in meeting Member needs
- Reports medically complex cases to appropriate roles as necessary for review and problem solving
- Provides administrative support for care coordination Level 1 and Level 2 Service
- Coordinators as identified
- Coordinates care and efficient utilization of health care resources for patients identified in the Starplus program through communication with other members of the health care team, including physician offices, social workers, nurses, and other multidisciplinary team members as appropriate to obtain optimal outcomes for members
- Refers member to disease management team
- Maintains status on telephonic Service Coordination phone calls from the members and/or LARs to meet regulatory requirements
- Ensure thorough knowledge of the Star+Plus contract and meet all Service Coordination contract requirements
- Other duties as assigned
- High School Diploma/GED OR equivalent work experience
- Must be 18 years of age OR older
- Direct experience with the ABD/SSI population in 3 of the last 5 years.
- 4+ years of experience working within the community health setting in a health care role
- 1+ years of experience working with Microsoft Word, Excel, and Outlook
- Experience in long-term care, home health, hospice, public health or assisted living
- Experience in electronic charting
- Bilingual fluency in English and Spanish
- Knowledge of specific case management processes, and person-centered care practice
- Knowledgeable of all clinical resources available to patients both inpatient and outpatient
- Verbal and written communication skills
- Data entry and Word processing skills
- Must be willing to work on-site at the following location: 1145 Westmoreland Dr. El Paso, TX 79925
- Must reside in El Paso, TX
- Ability to work full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm MST. It may be necessary, given the business need, to work occasional overtime.
- Experience as a case management support staff, a customer service representative in a medical office or health plan, utilization review assistant, or an LTSS coordinator with DADS or DSHS
- Experience in a managed care environment
- Service coordination or case management experience
- Experience with the State of Texas STAR+PLUS program or similar programs dealing with SSI and disabled adults
- Medicare/Medicaid dual population