• 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 • Conduct 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 • May 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 • 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) • 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 • Participate in Care Team meetings and interdisciplinary team (ICT) conferences to support member care

• Interact with patients creating a friendly, caring culture with exceptional service. • Operate in a high volume, contact center environment to reach unscheduled patients. • Conduct tasks of the position in a collaborative, friendly and empathetic way. • Communicate to the patient the status of their insurance benefit, estimated cost, preauthorization, and payment options. • Triages and transfers calls, as needed.

Role Description This position is part of the clinical team. This position is responsible for performing overall nursing care within the electronic health record (EHR) and also provides a communication link between providers and patients on test results, medical questions and requests, and continuity of care. This is a remote position. Qualifications - Possession of a valid license as a Registered Nurse or Licensed Practical Nurse in the state where nursing practice will occur or multistate license in nurse’s resident state; multistate license strongly preferred. - Two years nursing experience in an outpatient clinic, preferred. - Must obtain Basic Life Support (BLS) certification through American Heart Association within six (6) months from date of hire. Requirements - Patient Care and Follow-up: Supports the provider and care team by managing all EHR tasks outside of medication refills and medication prior authorizations, this includes managing Telephone Encounters, Actions, Documents, and Lab/Diagnostic order follow-up and notifying patients of results. Follow up with patients on any outstanding orders for testing or specialty care to ensure these services are completed. Answer any questions the patient may have regarding the testing. Assists with non-medication prior authorizations such as DME and diagnostic imaging and testing. - Patient Coordination of Care: Supports the provider and care team by coordinating care for upcoming patient appointments or care between appointments. This includes reviewing provider schedule in advance of an appointment to optimize the patient visit. Reviewing health record for information surrounding immunization status, preventive services, and necessary lab testing for the visit and contacting the patient as needed to discuss. Reviewing health record for recent hospital stays and ensure hospital records have been received. Ensuring health record is up to date with any health information from external sources (i.e. hospitals, WebIZ, etc.). This position should develop a working understanding of the current UDS measure for patients served and assess, plan, implement and evaluate continuously the outcomes obtained. Participates in Care Team daily huddle to facilitate communication regarding patients being seen in the clinic. - Patient Triage: Answers triage phone calls and works with the care team Primary Nurse to schedule or work in patients who need to be seen by the provider. Serves as the primary contact for Mission Control. - The Nursing Care Coordinator whom focuses on CHC/SEK’s Diabetes Program will assist primary care nursing team with medication refills, prior authorizations, DME, diabetic shoes, and other items needed to provide quality continuous care for patients. - Performs other duties as assigned. The essential functions listed are not an exhaustive list of every task the employee is required to complete. Employees are expected to perform all other duties as assigned. Company Description

Outreach Concierge Navigator Bilingual in Spanish remote type Fully Remote locations Remote North Carolina time type Full time job requisition id R2069 The Remote Regional Concierge Navigator provides outreach and support to all our members, ensuring they have access to the care they deserve. Supports our members to navigate through their health care and benefits. Connects the dots between our provider network, health plan operations, and supplemental vendors. Maintains a high knowledge of the member needs of their respective market and assist our members every step of the way to ensure they are never alone in their healthcare journey and have the highest level of coordinated care. Lays the groundwork for future and ongoing member support. Has familiarity with assigned markets and understands the meaningful contributions to members’ healthcare outcomes. GENERAL DUTIES/RESPONSIBILITIES Provides in-market, specialized member support in respective market or region. Conducts in-market member engagement including Welcome Calls, New Member Onboarding, JSA Scheduling, High Quality PCP and Provider Terms, Product/Vendor Changes, CAHPS Proxy, Disenrollment Quality Assurance, and Proactive Service Recovery Conducts case follow-ups and quality member issue resolution for all cases assigned. Ensures members have access to PCP and specialists to coordinate care. Educates members on gaps in care and assists with scheduling provider appointments. Serves as the patient's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures. Makes appropriate and timely patient appointments, reminders, and confirmations and Mails letters and correspondence as needed. Places regular/consistent outreaches to the patient Communicates with PCP with any member updates and requests. Assists with obtaining medical records from any healthcare providers involved in care or hospitals. Helps members with any authorizations and referrals involved in their care plan. Resolves incoming calls concerning members’ eligibility, benefits, provider information, clinical, and pharmacy needs; coordinate membership changes such as member’s primary care physician and proactively engage member with their wellness plan options. Participates in on-site member engagement activities as needed, such as in-person member meetings, handling lobby calls at a retail or care center location, etc. (subject to change). Other duties as assigned. Job Requirements: Experience: • Required: Minimum 1 year of customer service experience. • Preferred: High-volume inbound customer service experience, particularly for health plan or Medicare “Member Services” roles in health plan and supplemental benefits preferred. Telemarketing and/or member outreach experience preferred. Specialized experience in escalation or resolution units preferred. Education: • Required: High School Diploma or GED. Specialized Skills: • Required: - Knowledge of ICD-10 and CPT codes. - Keyboard typing 40+ words per minute. - Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations. - Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. - Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; - Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization. - Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations. - Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly - Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. • Preferred: Bilingual English/Spanish or English/Vietnamese or English/Mandarin. Fluency in written and verbal Spanish, Korean, or Vietnamese, a plus. Licensure: • Required: None Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this 100% remote job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1 While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. 2 The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range: $44,790.00 - $67,185.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.