CareFirst Careers

Community Health Worker (MD Medicaid)

Resp & Qualifications

The Community Health Worker is supporting the CareFirst Maryland Medicaid Program

Position Summary: Reports to the Clinical Operations Manager of Medicaid Case Management and Special Needs and performs under minimal supervision providing coordination of care, maintenance of databases, and the production of reports. Community Health Workers (CHWs) are frontline public health workers who have a close understanding of the community they serve.  Building trusting relationship enables CHWs to help individuals access resources including medical, social services, quality of care and health information.  The community health worker (CHW) is a remote position working with special populations who may have chronic physical conditions, serious mental illness, substance use disorders and/or homelessness.  This position assists the Integrated Care Team (Nurse Case Manager and Social Worker, Primary Care Physician, Behavioral Health Provider) by finding the member and proactively coordinating care for members facilitating the achievement of quality and cost-effective health outcomes.

Essential Job Duties and Responsibilities:

  • Serves as a point of contact for health care services and referrals for members with medical and behavioral health needs.
  • Locate members, at their home or in the hospital, who are difficult to contact or are under/over utilizers of health care services and offer face to face evaluation of needs.
  • Provides a brief assessment for safety risks, health needs and barriers to care, offering resources as needed.
  • Ability to quickly establish trust with people and build relationships.
  • Working closely with case managers, social workers and special needs coordinators integrating case management to meet all medical, behavioral, and psychosocial needs. 
  • Collaborates with members, families, and healthcare providers to enhance patient wellness and facilitate connecting members to care.
  • Assess and refer members with psychosocial needs to DSS and/or social services programs.
  • Helps individuals and families understand health conditions and develop strategies to improve their health and well-being. 
  • Advocates for members coordinating appointments and accessing services.
  • Monitors member compliance and is available to provide consultation as needed.
  • Document all activities in the appropriate system(s) in a timely way.
  • Some evening and weekend hours may be required.
  • Other duties as assigned.


Education, Experience and Qualifications:

  • High school diploma OR GED and minimum two years’ experience in behavioral health, social service, health care and/or education.
  • Prefer an education level normally acquired with the completion of an AA degree or bachelor’s degree in human services, social work, sociology, or health care with a minimum of one years’ experience with the target population.
  • Certified Community Health Worker preferred, but we will train and certify qualified candidates upon hire.
  • Public health experience a plus.  
  • Experience and a strong knowledge base of community resources.



Knowledge, Skills and Abilities:

  • Strong work ethic built on a foundation of proactivity and teamwork.
  • Prioritize and organize work to meet changing priorities.
  • Knows and understands specific health issues and the health care /social services systems. 
  • Must have the ability to perform complex and diverse administrative duties that involve application of procedures, interpretation of data, and demonstrate appropriate judgment.  
  • Able to maintain professional boundaries with members and coworkers.
  • Ability to monitor, review and resolve patient needs including addressing barriers to care.
  • Working knowledge of social and health issues as well as familiarity of community resources.
  • Communicates in an effective and professional manner, and maintains positive relationships with physicians, nurses, social workers, care management and community resources.
  • Able to set and meet deadlines working independently, as well as on a team.
  • A positive attitude, with an ability to work hard in a fast-paced, highly complex and dynamic movement for healthcare reform.
  • Even-tempered and able to adjust tasks in accordance with changing priorities.
  • Personal and professional record of accomplishment that demonstrates a commitment to quality in healthcare.
  • Willingness to “think outside the box”, being a problem solver, accept feedback, and embrace the challenges working with special needs members.
  • Accompany members to appointments as needed.
  • Use critical thinking and defined policies and procedures to coordinate and manage the flow of information within area of responsibility.
  • Compile, analyze, and organize data and information from multiple sources to carry out assignments.
  • Ability to work with diverse individuals and groups demonstrating cultural competency. 
  • Bilingual preferred. 


Computer Skills:

  • Proficiency in Microsoft Office, Word, and Excel
  • Experience with Electronic Health Records preferred.


Driving and other requirements:

  • Required to use personal vehicle to carry out job duties.
  • Must possess and maintain a valid driver’s license.
  • Must provide a current motor vehicle record.
  • Must provider current personal owner liability automobile insurance and maintain coverage throughout the course of employment in the position.

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 12/16/2020

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

Learn more about Medical Management