• Provide administrative support to the members of the CM team • Collect data for Health Risk Assessments (HRA) • Screen for eligibility and benefits • Identify members without a PCP and refer to Member Services • Screen members by priority for CM services and refer as appropriate • Perform transition of care duties to include, but not limited to, contacting the members’ PCP, Medical POA, or other medical providers for information pertaining to special needs • Document all encounters and contacts made on behalf of clients; complete and submit monthly reports; maintain comprehensive electronic member records • Motivate members to be active and engaged participants in their health and overall well-being • Provide educational promotion, member follow-up, arrange PCP visits, and perform care coordination under the direction of the Care Manager • Assist members in assessing health-related services, including but not limited to obtaining a medical home, providing instruction on appropriate use of the medical home, overcoming barriers to obtaining needed medical care, and/or social services • Perform tasks as directed by the CM team to promote member compliance, such as verifying appointments or obtaining medical records • Facilitates member access to community resources, including, but not limited to, finding housing, food, clothing, prenatal classes, parenting, and providers to each life skill, and relevant mental health services • Work collaboratively and effectively within a team • Establishes positive, supportive relationships with participants and provides feedback to other members of the team • Builds and maintains positive working relationships with members, providers, nurse care managers, social workers, agency representatives, and office staff, from diverse cultural and socio-economic backgrounds