Care Advocate (Bilingual Desired)

Job Title

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration. - Our commitment is to: Strive to apply an equity lens to all our work. Reduce health disparities. Create an equitable work environment.

About the Role

Responsible for supporting CHPW's Medicaid, Cascade Select, and Dual Special Needs Plan (DSNP) members in navigating benefits and health care systems to promote optimal health and a positive experience with the Health Plan. This role conducts new member outreach such as welcome calls and Health Risk Assessments, as well as routine outreach to complete annual Health Risk Assessments, promote health screenings and engage members in the Care Management programs. Position may also serve as a primary contact for the Care Teams, receiving inbound calls from members to resolve members needs or triage to the appropriate CHPW staff or team. This role is an active participant of the Care Management Care Teams.

To be successful in this role, you:

• Have three (3) years in administrative, customer service, and/or patient services coordination (referrals, appointments, etc.) in a healthcare services field required or,
• Have one (1) year as a Medical Assistant or related field, preferred
• Are certified through an accredited medical assistant program, Allied Health education program, or other related certification, preferred
• Have working knowledge of medical terminology, electronic medical records, and healthcare process preferred.

Essential functions and Roles and Responsibilities:

• Conduct telephonic outreach to identified members to complete Welcome Calls, member satisfaction surveys, and Health Risk Assessments (HRAs).
• Educate members on accessing benefits, routine health screenings, program requirements (e.g., face-to-face visits, individualized care plans, interdisciplinary care team meetings), and how to engage with the Care Team.
• Schedule and coordinate in-home assessments with Community Health Workers (CHWs), and telehealth or in-person provider visits with participating Community Health Centers (CHCs).
• Conduct quarterly outreach to members previously unreachable (UTR).
• Support members in closing care gaps and scheduling appointments with community or in-home providers.
• Triage inbound calls from members, families, and caregivers; resolve issues or refer to appropriate staff.
• Receive warm handoffs from internal teams (e.g., Sales, Pharmacy) for members needing HRAs or Care Team support.
• Provide educational materials via phone, mail, or text as directed by the Care Team.
• Participate in Care Team meetings and interdisciplinary team (ICT) conferences to support member care.
• Refer members to internal programs by connecting them with the appropriate CHPW teams.
• Access and manage medical records, including uploading documents and maintaining electronic health record (EHR) episodes.
• Close EHR cases for members no longer enrolled and notify the assigned case manager.
• Activate the Crisis Caller in Distress process to support members in crisis.
• Prioritize and complete daily tasks independently and collaboratively.
• Perform other duties as assigned. Essential functions may be revised at the employer's discretion

Knowledge, Skills, and Abilities:

• Ability to speak Spanish preferred.
• Ability to meet scheduled deadlines, manage time, organize, and prioritize work.
• Effective verbal and written communication skills.
• Ability to use Microsoft Office products such as Outlook, Word, and Excel.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check

Criminal History includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Non-Exempt and is eligible for overtime. Based on market data, this position grade is 42 and has a 5% annual incentive target based on company, department, and individual performance goals.

CHPW offers the following benefits for Full and Part-time employees and their dependents:

• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• Time off including PTO accrual starting at 17 days per year
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical:

• Extended periods of sitting, computer use, talking, and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
• Frequent torso/back static position; occasional stooping, bending, and twisting.

Mental:

• Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.

Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

The above is intended to describe the general content of and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities, or requirements of this position. Job descriptions may be updated or changed to reflect business needs.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.