Care Guide Resource Specialist
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Job Location:
Somerville, NJ - USA
Hourly Salary:
$ 19 - 27
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
The OpportunityMass General Brigham Health Plan is hiring two Care Guides to actively participate with the Interdisciplinary Care Team (ICT) and serve as an additional point of contact for DSNP members. This role involves proactive outreach and timely responses to inbound inquiries and service requests with the primary objective of helping members access their insurance benefits and obtain the care they needultimately simplifying and enhancing their healthcare experience.
The Care Guide supports enrollees by assisting them in identifying a primary care provider (PCP) when necessary coordinating follow-up appointment scheduling and providing reminders for upcoming lab tests and medical visits to encourage adherence to care plans. Additionally the Care Guide is responsible for closing care gaps by reviewing member medical data facilitating the scheduling of overdue appointments and screenings and collaborating closely with providers and the ICT to ensure comprehensive care management.
Responsibilities and caseload may be adjusted in response to changes in enrollment trends.
Essential Functions
Proactively contacts enrollees to schedule and remind them of upcoming appointments overdue screenings pre-visit labs and conducts ongoing check-ins to assess their needs.
Closes care gaps by analyzing data from electronic health records enrollee registries claims and care team information to drive outreach and improve quality measures and performance outcomes.
Establishes and maintains positive relationships with local practice teams community-based organizations and vendors to support enrollee needs and facilitate coordinated care.
Coordinates tailored outreach strategies for populations requiring chronic disease management and preventive care ensuring efficient communication and avoiding duplication with plan and practice outreach efforts.
Assists enrollees in accessing plan benefits overcoming barriers to care finding primary care providers scheduling appointments and navigating healthcare services.
Supports service request management authorization monitoring and compliance adherence.
Participates in multidisciplinary population health initiatives focused on reducing disparities and enhancing care quality.
Follows established communication protocols and provides updates to clinical teams health plan staff and leadership as needed.
Contributes to quality improvement initiatives the design of population health processes and performs additional duties as assigned by the supervisor.
Qualifications
- High School Diploma or Equivalent required; Associates or Bachelors Degree Related Field of Study preferred
- At least 2-3 years in direct healthcare delivery systems or relevant work experience within care required
- Experience with Medicare and Medicaid preferred
- Bilingual candidate highly preferred English and Spanish Portuguese French and/or Chinese
- Competent in working with multiple healthcare computer platforms with EPIC experience considered a plus and able to work effectively in a fast-paced medical environment across multiple practice locations.
- Experienced in supporting individuals with complex medical behavioral and social needs utilizing knowledge of healthcare and community services to assist enrollees effectively.
- Strong customer service skills with a positive friendly kind and patient demeanor to engage enrollees and interdisciplinary teams effectively combined with excellent oral written and telephonic communication abilities.
- Demonstrates critical thinking problem-solving skills and autonomy in decision-making while maintaining strong organizational skills to manage routine work triage and reset priorities as needed.
- Exhibits strong interpersonal skills to work collaboratively with providers and their staff building rapport and trust to promote Population Health initiatives.
- Comfortable with change and adaptable able to pivot as part of continuous process improvement activities working independently while contributing to a collaborative team environment.
Skills and Abilities
- Familiarity with medical terminology.
- Familiarity with community services/resources.
- Ability to maintain effective working relationships with patients/families.
- Knowledge of current community resources.
- Strong assessment and crisis intervention.
- Strong collaborative skills and a desire to work in a complex fast-paced environment.
- Excellent interpersonal skills.
- Excellent collaboration customer service and advocacy skills.
- Excellent written and verbal communication skills.
Additional Job Details (if applicable)
Working Model Requirements
- M-F Eastern Business hours required
- Remote work requires a stable secure compliant and quiet workstation with a lockable drawer. Teams Video access required via MGB provided equipment
- Meeting onsite is optional. Must be able to share community-based details and resources for local areas and surrounding areas (helping members locate resources in the area is key local to MA knowledge required)
This fully remote position primarily serves members enrolled in the One Care and Senior Care Options (SCO) programs focusing on populations residing in Essex Middlesex Suffolk Norfolk Plymouth Bristol Dukes and Nantucket counties.
Responsibilities and caseload may be adjusted in response to changes in enrollee enrollment trends.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$19.42 - $27.74/HourlyGrade
3EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
IC
Key Skills
- Employee Relations
- Typing
- Succession Planning
- Human Resources Management
- Military Experience
- Case Management
- Benefits Administration
- HRIS
- Payroll
- ADP
- Human Resources
- Leadership Experience
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
