Community Connections Representative I/II (Buffalo and ...

Excited to grow your career?We value our talented employees, and strive to help employees grow professionally. If you think the open position you see is right for you, we encourage you to apply Job Description: Summary: This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about accessing community resources and assists with navigating resources available and provide assistance with addressing SDoH barriers and care gaps. This position educates and assists with the enrollment and recertification process for Marketplace Facilitated Enrollment (MFE): On and Off Marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market - Qualified Health Plan (QHP). This position requires working occasional evenings and weekends for outreach and community events. Must be able to drive independently within the Health Plan regions Essential Accountabilities: Level I u2022 Educates Medicaid, Medicare, and Commercial members on healthcare benefits, and community resources through home visits and outreach. u2022 Educates and assists members with accessing care, Case Management program and benefits and government cell phone programs. u2022 Coordinates, plans and attends community events, including school events, health fairs and various community initiatives. Proactively informs and increases awareness of heath care offerings, state regulations and the Excellus/Univera brand/products at said events and within assigned territories. u2022 Completes scheduled and unscheduled home visits for noncompliance, gaps in care, community resource needs, and other high-risk issues. u2022 Conducts targeted phone calls for compliance, HEDIS initiatives and health risk assessments. u2022 Collaborate with Case Management on the status of high-risk member referrals. u2022 Assists in finding and connecting members to community social services and agencies. Enroll or refer qualified members in a health home. u2022 Communicates health insurance program options, fundamentals of all the health insurance products, benefits, and associated costs based on analysis of the applicantu2019s situation in Marketplace. u2022 Assists individuals and families with securing and providing required documentation to demonstrate age, residency, and income as is required by the Marketplace. u2022 Interprets a variety of complex instructions from the MFE Training Manual to assist applicants. Provides critical assessment and analysis which effects insurance enrollment for families and children. Presents all aspects of eligibility, enrollment and available products to community audiences. u2022 Meets with applicants in locations that have additional MFE resource backup. u2022 Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companiesu2019 mission and values and adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs. u2022 Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. u2022 Regular and reliable attendance is expected and required. u2022 Performs other functions as assigned by management. Level II (in addition to Level I Essential Accountabilities) u2022 Manage the incoming Community Connections Referrals. u2022 Maintain the Community Resource Guide as needed. u2022 Ensure educational materials and supplies are replenished and available for use. u2022 Maintain the in-house Food Pantry ensuring all non-perishable items are within use by date. u2022 Works with management to participate in training process for new hires and team refreshers. Supervise Intern and/or mentor new hires to team; providing first level problem resolution, share Lifetime way cultural expectations, ensure successful on-boarding and engagement in role. u2022 Works with management on establishing influential relationships in the community within assigned territory. u2022 Attends community IPA/Navigator Agency as instructed. u2022 Represents the company in small/large community-based organization meetings as required/complement or collaboration with Community Engagement Program Manager. u2022 Gain Subject Matter Expertise (SME) level in key focus area; develop training curriculum and facilitate workshop for team in conjunction with management team. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels u2022 High school diploma or GED required. Associate degree preferred. u2022 Minimum of two years of social services, community outreach, or education experience required. u2022 Marketplace Facilitated Enroller certification preferred. u2022 Demonstrated problem solving, interpersonal and communication skills. u2022 Prior experience and working knowledge in Microsoft Suite including Excel and Word. Level II (in addition to Level I Minimum Qualifications) u2022 Minimum of two yearsu2019 experience working in the Community Connections Representative role. u2022 Marketplace Facilitated Enroller certification required. Maintenance of certification through continuing education/training essential. u2022 Demonstrated attention to detail. u2022 Demonstrated leadership skills. u2022 Demonstrated knowledge and experience of health care industry and Health Plan business. u2022 Demonstrated ability to organize and represent an organization at community events preferred. u2022 Highly effective communicator. Physical Requirements: u2022 Ability to work in a home office for continuous periods of time for business continuity. u2022 Ability to travel across the Health Plan service region for meetings and/or trainings as needed. u2022 Ability to lift, carry, push, or pull 15 pounds or less. u2022 Reaching, crouching, stooping, kneeling required. u2022 Must have a valid Class D license and ability to operate a motor vehicle. u2022 The ability to hear, understand and speak clearly while using a phone, with or without a headset. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I: Grade N4: Minimum $19.22 - Maximum $30.76 Level II: Grade N5: Minimum $20.02 - Maximum $33.03 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the positionu2019s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. With about 4,000 employees, 31 counties, and serving the needs of over 1.5 million members, you can imagine the gamut of skills it takes to keep our organization growing and our members flourishing. As an internal job seeker, this means growth and development in many directions, divisions, and roles.Take a look at information regarding our hiring process here. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Created: 2025-12-04