Community Services Coordinator

Join Our Team at Optum Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, and data they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Schedule: FT, 40 hrs. Monday - Friday, 8:30am - 5pm. Location: 111 Grossman Dr. Braintree, MA 02184-4997. This role is Hybrid in MA. Will be required to work onsite for a minimum of 2 days per week and provide coverage at sister site when needed. Primary Responsibilities: Contacts patients and families identified via registry or referred by care teams and program staff, to provide guidance, advocacy, and support throughout the care process, including transitions and specialty care needs. Forms and maintains relationships with patients and families, demonstrating sensitivity to health literacy, preferred language, cultural beliefs, identity, and values impacting care, and staying in touch over time when necessary to ensure gaps are addressed and care plan adherence is in place. Identifies potential gaps in care planning, condition self-management, and potential presence of barriers to adherence to their plan of care. Collaborates with primary care teams, case management, nurse case managers, specialists, behavioral health providers, nutrition, social work, insurers, and community partners to coordinate comprehensive care. Screens for at-risk and medically complex patients for clinical and social triggers (SDoH) that may require intervention and escalates concerns appropriately. Tracks and supports patient adherence to appointments, laboratory tests, diagnostic studies, referrals, and prescription compliance with goal of closing gaps in preventative health and chronic condition(s). Conducts high-volume patient outreach via telephone, patient portal messages, mailings, and virtual or in-person encounters to support care plans and follow-up needs. Processes and coordinates referrals, including specialty care, behavioral health services, and community-based resources. Assists patients and families in navigating insurance and benefit programs (e.g., MassHealth, Social Security, CommonHealth), as well as community resources addressing transportation, nutrition (WIC/SNAP), housing, utilities, and durable medical equipment. Provides direct support to patients and families accessing and navigating complex medical, behavioral health, and social service systems. Documents all outreach, care coordination activities, outcomes, and relevant patient information accurately in the electronic medical record to ensure continuity of care. Maintains up-to-date community resource lists and reviews population health tools such as registries to identify and address care gaps. Coordinates and leads regular panel or roster reviews, including chronic disease management and complex care reviews, to support team-based care planning. Supports Patient Advisory Council meetings and other patient engagement activities, including gathering feedback and assisting with implementation of improvement initiatives. Maintains collaborative relationships with community organizations, advocacy groups, and stakeholders to enhance patient support and access to services. Attending meetings, training, and community outreach or educational activities to support program goals and continuous improvement. Performs other duties as assigned. Accesses only the minimum necessary protected health information (PHI) for the performance of job duties. Actively protects the confidentiality and privacy of all protected health information they access in all its forms (written, verbal, and electronic, etc.) taking reasonable precautions to prohibit unauthorized access. Complies with all departmental privacy policies, procedures, and protocols. Follows HIPAA privacy guidelines without deviation when handling protected health information. What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include: Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays Medical Plan options along with participation in a Health Spending Account or a Health Saving account Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement Employee Discounts Employee Assistance Program Employee Referral Bonus Program Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: High School / GED 2+ years of experience in a healthcare or clinical setting (human services preferred) Intermediate proficiency with Microsoft Office - especially Word and Excel Preferred Qualifications: A Bachelor's degree in related fields (typically in healthcare administration, psychology, sociology, Human Services, etc) EPIC experience Bilingual (any language) Knowledge and understanding of medical/healthcare terminology is strongly preferred Skills: Strong interpersonal and communication skills are needed with the ability to interact effectively with patients and medical professionals Ability to demonstrate a high level of cultural competence and sensitivity to patient needs and concerns Ability to engage patients in problem solving Sound judgment with the ability to work and make decisions in a fast-paced environment Excellent telephone skills, strong customer service and ability to build relationships with patients are required Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18 to $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.