Health Plan Resource Coordinator

Company Description

Compass Rose Health Plan provides comprehensive insurance solutions tailored for federal employees and their families. With over 75 years of stability, it offers Federal Employees Health Benefits (FEHB) plans, including Standard Option, High Option, and Compass Rose Medicare Advantage. Dedicated to SERVICE, STABILITY, and SECURITY, the health plan ensures federal employees and retirees are supported at every step. Compass Rose Health Plan is committed to delivering reliable benefits and resources for its members.

Position Summary

The Health Plan Resource Coordinator supports Compass Rose health plan members by helping them navigate benefits, access care, and connect to healthcare and community resources. This role provides proactive outreach and responsive member support, collaborates with healthcare providers and internal teams, and addresses social, clinical, and care coordination needs that impact member well-being. This role requires a health and human service degree or equivalent and certification in case management, or equivalent.

Education

· Bachelor’s degree in a health and human services field, or equivalent experience.

· Experience or certification in case management, social work, or equivalent, with a focus on direct member advocacy and resource coordination.

Qualifications

· 5 years working in support of a diverse population.

· Previous experience coordinating services.

· Previous experience working in health insurance is preferred.

· Familiarity with and understanding of local resources and programs available including transportation, health services, community support organizations, recreational and wellness activities.

· Excellent verbal and written communication skills.

· Ability to individually plan, organize and maintain complex tasks, files, email, calendar, and program demands.

· Keen attention to details.

· Self-starter with the ability to complete assigned work independently.

· Function well in a team environment.

· Ability to maintain professionalism in stressful situations.

· Positive attitude.

· A working knowledge of MS Word, Excel, and PowerPoint as well as proficiency in learning and using online/cloud-based databases, communications, and other resources.

· Patience and ability to assist and teach others to use electronic resources such as phone apps, websites, web-based portals, and other communications tools.

· Must be able to work for any employer in the U.S.

· Must reside in the United States or its territories.

· Must have reliable internet access and ability to work remotely.

Health Plan Resource Coordinator — Core Duties

· Provide Compass Rose health plan members with personalized support to promote quality of life and address care coordination needs across the continuum of care.

· Identify members who may benefit from additional support by assisting with the creation, monitoring, and analysis of custom reports and utilization data.

· Conduct proactive outreach to identified members and respond to inbound calls through the wellness telephone lines.

· Maintain and continuously build a comprehensive resource library, including but not limited to community-based services, transportation, social support programs, and health and wellness resources.

· Assist members with understanding and resolving medical and pharmacy benefit questions.

· Collaborate with members’ health care teams (e.g., providers, case managers, pharmacists) to coordinate care, services, and referrals.

· Establish and maintain relationships with community organizations and vendors to support identified member needs.

· Assist members in navigating the healthcare system to reduce administrative burden, improve access to care, and support informed decision-making.

· Document member interactions, referrals, and outcomes in accordance with health plan policies, privacy requirements, and documentation standards.

· Screen members for social determinants of health (SDOH) need and coordinate appropriate referrals and follow-up.

· Track and report trends, barriers, and outcomes related to member support and resource utilization to leadership and quality teams.

· Support quality improvement initiatives by identifying gaps in care, resource needs, and opportunities to enhance member engagement.

· Assist with coordination of transitions of care, when applicable, to support safe and timely follow-up after hospitalizations or major health events.

· Provide education and guidance to members regarding available programs, benefits, and community resources.

· Collaborate with Compass Rose clinical staff to address any healthcare needs out of this position’s scope, knowledge, licensure, and/or certification.

· Adhere to all applicable regulatory, confidentiality, and compliance requirements, including HIPAA and internal Compass Rose policies.

Other duties as assigned.