Your Role
The Community Programs team provides high-touch engagement with members and community-based organizations to remove barriers to healthcare access, enhance population health initiatives and advance health equity.
The Community Health Advocate will report to the Community Resource Center Manager, Operations and will be assigned to the West and Panorama City Community Resource Centers.
In this role you will be assisting members who have complex health and / or social needs, assessing their immediate needs and addressing barriers to care to include, but not limited to, care coordination, linkages to health plan services and community resources.
Your Work
In this role, you will :
- Assess psychosocial and social determinants of health needs for moderate-risk members and document assessment results or augment available information in appropriate systems
- Assist members with problem-solving barriers to moderate health conditions by identifying, locating, connecting to and navigating needed community and medical system services, including visiting members at their homes, accompanying members to medical appointments and assisting members with completing forms to access needed services
- Actively engage, build rapport and establish trusting relationships and facilitate collaborative communication with members and member family support systems
- Consult with or refer members to licensed staff (social worker, nurse case manager etc.) as required based on member social, health risk and medical complexity
- Conduct follow-up activities to connect or reconnect members to health plan services, their provider or community-based agencies
- Serve as a member advocate for health plan, provider and community services and resources
- Identifies social determinants of health concerns / gaps, develops and documents a plan to address moderate social and health disparities in accessing appropriate care and services
- Documents member updates and progress notes in appropriate systems, submits timely reports, and provides recommendations for improved member outcomes tracking
- Identifies gaps in community resources and medical systems and supports the implementation of new solutions or services to close identified gaps
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