Troy Medicare is hiring for a Community Health Worker who serves as a liaison to our members to assist with access to appropriate care. They will be responsible for utilizing community and health plan resources to implement case management strategies focusing on social determinants of health. This position will be working closely with our Care Management team who operates Monday - Friday from 8a.m. to 5p.m. EST.

Troy Medicare started in Concord, North Carolina when our founders saw so many people increasingly unable to afford their prescriptions. Big health insurance companies have become more expensive and less transparent in pricing and benefits. Our mission is to provide every member with a comprehensive and easy-to-understand Medicare plan.

This is a HYBRID position that will work from home with frequent daily travel within the Troy network. Including but not limited to the following counties: Montgomery, Moore, Hoke, Robeson, Cumberland, Columbus, Bladen.

Job Responsibilities:

• Research and utilize all resources for members
• Set up DME (durable medical equipment) needs for members
• Perform chronic disease education
• Address social determinants of health issues
• Verify member’s eligibility and benefits
• Travel will include visiting members in their homes or facilities, pharmacies, and providers
• Collaborate with CM team lead, Care Managers, and Care Coordinators to solve more complex problems
• Excellent and professional communication with providers and members
• Complete health risk assessments for assigned members
• Communicate with members, family, caregivers, and providers to ensure appropriate care
• Prioritizes and organizes own work to meet turnaround time and deadlines
• Processes work as assigned within established timeframes and productivity goals using department resources and procedures with minimal oversight
• Follows record management and documentation protocols
• Supports peers on the team with other duties to help maintain turnaround times
• Assist in other tasks as assigned.

Requirements:

• High School diploma (required)
• 2+ years of working experience, preferably in the managed care field/insurance provider
• An understanding of Medicare and HMO health plan eligibility and benefits
• General knowledge of Medicare Advantage plans and the authorization processes
• Knowledge of medical terminology
• Ability to maintain the confidentiality of all member information
• Ability to communicate effectively before groups of customers or employees of the organization
• Ability to work in a remote environment and utilize resources independently with minimal supervision
• Experience in referral/authorization processes as well as intake experience
• Familiar with Google Suite programs. These are vital to our daily communication within the organization
• Experience with MAC computers
• Quickly receives direction from team lead and supervisor for all issues/concerns to be addressed
• Must have valid driver's license, current vehicle insurance, and reliable transportation
• Certified CHW is a plus

Compensation:

Commensurate with experience

Physical Demands and Work Environment

An employee must meet the physical demands described here to perform the essential functions of this position successfully. Reasonable accommodations may enable individuals with disabilities to perform the operations. Work involves exerting up to 20 pounds of force occasionally and a negligible amount of force constantly to move objects. Using arm and leg controls requires exertion of force greater than that for Sedentary Work, and the worker sits most of the time; the job is rated for light work.