Job Description

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Community Health Coach will conduct in-person care management visits to identify and provide appropriate interventions based on the psychosocial, environmental, and spiritual needs of the member. The employee will provide education on how to access covered and non-covered benefits and ensure continuity of care across all healthcare settings by collaborating with the interdisciplinary team; Primary RN/SW Care Manager and member/members representatives. Utilize benefit structure and community-based resources to address member needs. Educate members on preventative health, and quality of life interventions. Community Health Coach will be knowledgeable in and adhere to CMS/DOH regulations and policies. The Community Health Coach is responsible for the completion of in-person care management visits to Elderplan/HomeFirst members semi-annually as per pre-established criteria & care management scripts to identify Social Determinants of Health (SDOH) needs while in the members home, in accordance with departmental workflow. They educate members on plan benefits, preventative health, Advanced Directives/Health Care Proxy/Power of Attorney (POA) and help to facilitate the completion of such documentation. The Community Health Coach will collaborate with the Primary Care Management, report findings, & submit completed documentation to the Support Staff Supervisor.

• Bachelors degree in Social Work, psychology or related health field preferred .
• Minimum 1-2 years of relevant work experience in long term care, managed care, home care, geriatrics, hospital setting, or hospice.
• Prior experience in an interdisciplinary service delivery environment preferred.
• Working knowledge of Medicare and Medicaid regulations.
• Strong background in addressing Social Determinants of Health/Certification.

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