Community Outreach Technician

MCS Puerto Rico; San Juan (PR); On-site; USD 30,000 - 45,000; Full time

Job summary

MCS Puerto Rico seeks a Community Outreach Technician to provide administrative support in case management by assessing the non-clinical needs of policyholders. This role involves coordinating community-based services according to the individual's preferences and needs. Candidates should have an Associate's degree or equivalent, experience in customer service, and be bilingual in Spanish and English.

The position requires home visits and effective communication and planning skills. A valid driver's license in Puerto Rico is also necessary.

Qualifications

• 1 year of experience in customer service, preferably in the Health Insurance Industry.
• Valid driver's license in Puerto Rico required.
• Availability to travel throughout the island.

Responsibilities

• Support case management by assessing policyholder needs.
• Facilitate coordination of community-based non-clinical services.
• Conduct home visits to evaluate psychosocial needs.

Skills

Communication skills

Interpersonal skills

Bilingual (Spanish and English)

Customer service experience

Education

Associate’s degree or 60-64 university credits in Health, Social Sciences, or related areas

Job description

General Description

The Community Outreach Technician provides administrative support within the case management process for addressing the non-clinical needs of policyholders referred to the unit’s program. This role involves assisting in the development of individualized care plans based on evaluations that include assessing psychosocial needs, general physical health, and, when applicable, visual inspections of the policyholder’s living environment. The technician collaborates with the interdisciplinary team to identify priority needs, especially for high-risk and special needs policyholders. They facilitate coordination of community-based non-clinical services aligned with the policyholder’s preferences and ability to pay. Additionally, the technician supports clinical staff by locating policyholders referred to or active in Care Management programs, following established unit policies and procedures. They also plan and organize daily work activities to efficiently complete face-to-face assessments, coordination, and interventions within the timelines set by the care model.

Employment Details

Regular
Exempt

Essential Functions

• Processes interdepartmental and internal Care Management clinical staff referrals at the electronic files’ apps. Coordinates calls and home visits to conduct assessments, specific observations of barriers to care, medication inventories, document management, gathering useful information about the policyholder’s conditions, and other follow-up activities according to the referral source.
• Evaluate the psychosocial needs and general physical health status of the policyholder on or before the first thirty (30) days after receiving the referral, either by telephone or at the policyholder’s residence, including the island municipalities of Vieques and Culebra, to establish and document in electronic files apps an individualized care plan according to established guidelines.
• Develop interventions aimed at the orientation and/or coordination of necessary non-clinical services that affect the policyholder’s health care following the policyholder’s preferences and the services available in their community under the established guidelines.
• Performs home visits to policyholders who cannot be reached by phone to work on the Readmissions Prevention and/or Transition of Care initiatives within three business days after receiving the referral to establish contact. Performs readmissions prevention estimate and refers the estimate information to the case manager as soon as possible.
• Conducts home visits to policyholders participating in Complex Care Management programs within fifteen (15) working days of receiving the referral to re-establish contact when communication between the policyholder and the care manager is interrupted, following the operational guidelines for the case closure process.Guides the policyholder, family, and/or caregiver on community resource options and medical plan benefits in a timely and accurate way to ease informed decision-making and satisfy the policyholder.
• Documents and keeps an updated bank of community resources, including government agencies, non-profit organizations, and community organizations.
• Coordinates all arrangements with resources in the community related to referrals for the following non-clinical services and follows up as needed:
• Community Transportation Alternatives
• Home Food Service Alternatives
• Alternatives for Acquisition of Medical Equipment Not Covered by Medicare
• Alternatives for Housekeeping Services with or without charge
• Caregiver Respite Services Alternatives (Day Care)
• Recreation Alternatives or Multiple Activities Center
• Guidance and Documents for Parking Permit Applications in the form of Removable Parking Placards for People with Physical Impairments, DTOP
• Works with referrals to clinical physical health and mental health programs based on needs assessment surveys.
• Identifies visual, hearing, or language barriers that require referral to Customer Service for special service coordination.
• Documents in the electronic files apps updates and closure of care plans and non-clinical cases following applicable guidelines and procedures for reporting purposes and operational, quality, and compliance metrics.
• Take part as needed in Complex Interdisciplinary Team meetings as a component of the policyholder’s Care Management team on the social and non-clinical aspects to provide recommendations and/or facilitate implementation of the committee’s recommendations.
• Cooperates with the updating of demographic information in the company systems.
• Actively collaborates with the company care managers to handle the document of Authorization for Use and Disclosure of Health Information for those policyholders and/or caregivers who have significant barriers to managing them.
• Coordinates emergency referrals with agencies such as the Family Services Department, Office for Retired and Senior Citizens, 911, and the company solutions crisis line for those policyholders in need.
• Refers to the management situations that affect their duties' performance.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

Minimum Qualifications

Education and Experience: Associate’s degree and/or sixty to sixty-four (60-64) university credits equivalents in Health, Social Sciences, or related areas. At least one (1) year of experience in customer service or related areas, preferably working within the Health Insurance Industry.

Certifications / Licenses: A valid driver's license in the Commonwealth of Puerto Rico is required. Other: Availability to travel throughout the Island.

Languages: Spanish – Intermediate (comprehensive, writing and verbal). English – Intermediate (comprehensive, writing and verbal).

Proven experience may be replaced by previously established requirements.

We are an Equal Employment Opportunity Employer and take affirmative action to recruit protected veterans and individuals with disabilities.