Community Health Outreach Representative (Pittsburgh)

Job Summary

The Community Health Outreach Representative is responsible for conducting face-to-face outreach to members related to preventive health, maternity, care transitions, and chronic condition initiatives. This position educates members on available preventive health services, identifies potential barriers to care, and helps connect members with appropriate healthcare and community resources.

The position works directly with members, healthcare providers, community organizations, and government agencies to improve access to healthcare services. The Community Health Outreach Representative also assists members with Health Risk Assessments, appointment scheduling, referrals, and addressing barriers such as transportation, financial concerns, childcare, and healthcare knowledge.

This role requires strong customer service and communication skills, Medical Assistant experience, call center experience, and the ability to work effectively with diverse populations.

Key Responsibilities

• Conduct face-to-face outreach to members regarding preventive health, maternity, care transitions, and chronic condition initiatives.
• Educate members on the importance of targeted preventive healthcare services.
• Assess members for potential care management interventions and make appropriate referrals.
• Make referrals to Behavioral Health Managed Care Organizations (BHMCO) when appropriate.
• Contact members, healthcare providers, and community agencies to coordinate access to preventive health services.
• Develop supportive relationships with members and community organizations that encourage members to take an active role in their health and wellness.
• Assist members with completing Health Risk Assessments.
• Identify barriers affecting members' ability to access healthcare, including transportation, financial concerns, childcare, and healthcare knowledge.
• Provide members with guidance and resources to help address identified healthcare barriers.
• Assist members with scheduling healthcare appointments and answering questions regarding available services.
• Collaborate with human services providers, including Head Start Programs, WIC, community centers, and homeless shelters.
• Collaborate with appropriate state and community agencies, including Children and Youth Services (CYS) and juvenile probation, to identify and reach members who may need services.
• Maintain knowledge of available lines of business and member benefits to provide accurate and current information.
• Contribute to the development and preparation of educational materials for members and providers.
• Conduct provider and community training regarding Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services and other preventive health initiatives.
• Provide management and team members with summaries and outcomes of completed training activities.
• Participate in the development of measurable and innovative outreach programs designed to reach at-risk members.
• Represent the organization at community events, including events sponsored by community centers.
• Provide timely responses to members, providers, community organizations, and other internal and external customers.

Minimum Education & Experience Requirements

• High School Diploma or GED.
• Medical Assistant experience is required.
• Call center experience is required.
• Act 33, Act 34, and Act 73 clearances are required prior to starting the assignment. Clearances are not required at the time of candidate submission.
• Knowledge of customer service principles and processes, including assessing customer needs and meeting established service quality standards.
• Experience interacting effectively with customers, peers, and supervisors in a team environment.
• Ability to work effectively with diverse populations, including Medicaid members.
• Understanding of cultural competency and the challenges that may affect access to healthcare.
• Ability to work effectively with individuals with limited English proficiency.

Preferred Qualifications

• Experience in a healthcare-related customer service or marketing environment.
• Experience supporting member engagement in condition management or case management programs.
• Bilingual English/Spanish communication skills.
• Basic medical terminology knowledge.
• Experience working with the targeted community or population.

Knowledge, Skills & Abilities

• Strong customer service and member engagement skills.
• Strong written and verbal communication skills.
• Ability to establish rapport and supportive relationships with members.
• Patience and empathy when working with members and internal and external customers.
• Ability to independently identify problems and develop creative solutions.
• Proactive, self-directed, and assertive approach to problem solving and service coordination.
• Ability to manage multiple responsibilities simultaneously.
• Ability to respond promptly to member and customer needs.
• Knowledge of barriers that can affect access to healthcare, including transportation, childcare, financial challenges, and lack of preventive healthcare knowledge.
• Cultural awareness and sensitivity when working with diverse populations.
• Ability to coordinate with healthcare providers, community organizations, and government agencies.
• Ability to assist members with healthcare navigation, referrals, appointments, and Health Risk Assessments.
• Ability to communicate healthcare and benefit information clearly and accurately.
• Ability to conduct community and provider education and training.
• Ability to work both independently and collaboratively as part of a team.