Maternal Child Health Advocate

AllCare Management Services•Grants Pass, OR

13h

About The Position

This position is responsible for identifying social determinants of health needs for all AllCare Medicaid, Medicare, and Medicare dual eligible members of all ages, assisting in navigating the community-based network of services, providing benefit education, facilitating communication between the member and their providers, and assisting in member development of a self-management plan by performing the following duties below.

Requirements

High school diploma or general education degree (GED) is required.
Six months to one-year related experience and/or training in a related field is required.
Valid Oregon Driver’s License and vehicle insurance.
Mental Health First Aid Certification or willing to become certified within 90 days of hire.
Familiarity with the Healthcare industry.
Knowledge of the Oregon Health Plan and Medicare.
Excellent organization and time-management skills.
Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
Knowledge of and compliance with HIPAA regulations.
Knowledge of the widespread impact of trauma and paths for recovery.
Demonstrate accountability, inspiring trust and confidence from others.
Self-resolve most conflicts or misunderstandings with minimal need for direct supervision.
Effectively and professionally communicate with team members and customers.
Collaborate within a multidisciplinary, diverse team to provide professional service.
Cope and self-manage during stressful situations.
Maintain an attentive and empathetic demeanor.
Maintain a high degree of professionalism and confidentiality.
Effectively work with people with mental illness and from diverse backgrounds and experiences.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or employees of organization.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
Ability to apply concepts of basic algebra and geometry.
Has advanced basic computer job skills including logging on to systems, ability to communicate by email, ability to compose documents, enter database information, create presentations, download forms, and preserve/backup important data.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
The employee must be able to work onsite, as needed.
The employee must be able to occasionally travel locally.
Because of exposure to patient records of all types, the highest standard of patient confidentiality and privacy as established by business policy and HIPAA requirements must be maintained.

Nice To Haves

Bachelor's degree (BA) from a four-year college or university in a related field is preferred.
Traditional Health Worker (THW) certification through OHA is preferred (Subject to pay increase upon certification).
NPI number is required for the Traditional Health Worker (THW) Certification.
Doula Certification preferred.
Bilingual in English/Spanish is preferred, but not required, for this position (bi-lingual pay differential is applicable).

Responsibilities

Assessment, planning, implementing, coordinating and requesting services required to meet member’s health care needs to ensure timely access to medical, behavioral health, and community services and to ensure that all services are provided within HIPAA guidelines.
Acts as an advocate for members in problem resolution and facilitates collaboration with the interdisciplinary care team (ICT) in order to assist members to develop a knowledge base that will allow self-reliance.
Conducts thorough planning to determine and document specific objectives, goals, and actions to meet the member’s identified needs, including re-evaluation of the individualized care plan (ICP).
Assumes responsibility for a mixed acuity case load.
Facilitates consents and gathers clinical information.
Aids members to ensure timely access to medical, behavioral health, oral health, and community services to ensure all services are provided within HIPAA guidelines.
Participates as an integral member of an interdisciplinary team and is knowledgeable about the requirements of the Population Health Model of Care.
Develops an individualized care plan to meet the specific needs of the member.
Assists members to obtain referrals, order medications, services, and DME related to their current health care needs.
Assists members and their family/legal guardian to understand their health needs, improve health literacy, and follow treatment plans, including sending information from Healthwise and educational information created by AllCare Health.
Connects members and their family/legal guardian with services and community agencies to support their health and social determinant needs.
Refers members and collaborates with internal staff from the Enrollment, Member Services, Utilization Management, and Quality Management Departments.
Reviews cases and plans of care as indicated by member goals and identify needs, but not less than every 90 days.
Provides care coordination in a variety of settings as the need dictates (i.e., in the office, provider offices, other healthcare facilities, and member homes).
Coordinates provider and community partner services related to the members’ identified needs.
Acts as a key liaison in keeping lines of communication open between members, the interdisciplinary care team, physical and oral health providers, behavioral health, chemical dependency vendor, and/or DHS caseworker.
Conducts engagement activities and provides benefit information to members including those with mental health, physical health, and oral health care needs.
Develops and maintains a strong information base of community resources.
Acts as an advocate for the members in problem resolution.
Assist as needed in quality initiatives for the department.
Prepares for and participates in all required DSNP trainings, education, and member audits.
Participates in all initial, annual, and ongoing trainings.
Acts as a preceptor during the onboarding of new hire employees.
Maintains punctual, regular and predictable attendance.
Works collaboratively in a team environment with a spirit of cooperation.
Respectfully takes direction from care coordination leadership
Meets all required training including those listed in Relias Learning Module System (LMS)
Other duties as assigned.