Care Guide Resource Specialist

Mass General Brigham Health Plan
remote work
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Oct 30, 2025
The Opportunity Mass General Brigham Health Plan is hiring two Care Guides to actively participate with the Interdisciplinary Care Team (ICT) and serve as an additional point of contact for enrollees. This role involves proactive outreach and timely responses to inbound inquiries and service requests, with the primary objective of helping enrollees access their insurance benefits and obtain the care they need-ultimately simplifying and enhancing their healthcare experience. The Care Guide supports enrollees by assisting them in identifying a primary care provider (PCP) when necessary, coordinating follow-up appointment scheduling, and providing reminders for upcoming lab tests and medical visits to encourage adherence to care plans. Additionally, the Care Guide is responsible for closing care gaps by reviewing enrollee medical data, facilitating the scheduling of overdue appointments and screenings, and collaborating closely with providers and the ICT to ensure comprehensive care management. Responsibilities and caseload may be adjusted in response to changes in enrollee enrollment trends. Essential Functions Proactively contacts enrollees to schedule and remind them of upcoming appointments, overdue screenings, pre-visit labs, and conducts ongoing check-ins to assess their needs. Closes care gaps by analyzing data from electronic health records, enrollee registries, claims, and care team information to drive outreach and improve quality measures and performance outcomes. Establishes and maintains positive relationships with local practice teams, community-based organizations, and vendors to support enrollee needs and facilitate coordinated care. Coordinates tailored outreach strategies for populations requiring chronic disease management and preventive care, ensuring efficient communication and avoiding duplication with plan and practice outreach efforts. Assists enrollees in accessing plan benefits, overcoming barriers to care, finding primary care providers, scheduling appointments, and navigating healthcare services. Supports service request management, authorization monitoring, and compliance adherence. Participates in multidisciplinary population health initiatives focused on reducing disparities and enhancing care quality. Follows established communication protocols and provides updates to clinical teams, health plan staff, and leadership as needed. Contributes to quality improvement initiatives, the design of population health processes, and performs additional duties as assigned by the supervisor. High School Diploma or Equivalent required Associate's Degree Related Field of Study preferred Bachelor's Degree Related Field of Study preferred Field of Study: social sciences or health management or the equivalent Minimum 2 years in direct healthcare delivery systems or relevant work experience within care required Related experience 2-3 years preferred Experience with Medicare and Medicaid preferred Bilingual candidate highly preferred, English and Spanish, Portuguese, French, and/or Chinese Competent in working with multiple healthcare computer platforms, with EPIC experience considered a plus, and able to work effectively in a fast-paced medical environment across multiple practice locations. Field of Study: with significant relevant work experience may be substituted for a portion of the degree Experienced in supporting individuals with complex medical, behavioral, and social needs, utilizing knowledge of healthcare and community services to assist enrollees effectively. Strong customer service skills with a positive, friendly, kind, and patient demeanor to engage enrollees and interdisciplinary teams effectively, combined with excellent oral, written, and telephonic communication abilities. Demonstrates critical thinking, problem-solving skills, and autonomy in decision-making while maintaining strong organizational skills to manage routine work, triage, and reset priorities as needed. Exhibits strong interpersonal skills to work collaboratively with providers and their staff, building rapport and trust to promote Population Health initiatives. Comfortable with change and adaptable, able to pivot as part of continuous process improvement activities, working independently while contributing to a collaborative team environment. Skills and Abilities* Familiarity with medical terminology. Familiarity with community services/resources. Ability to maintain effective working relationships with patients/families. Knowledge of current community resources. Strong assessment and crisis intervention. Strong collaborative skills and a desire to work in a complex, fast-paced environment. Excellent interpersonal skills. Excellent collaboration, customer service and advocacy skills. Excellent written and verbal communication skills. Working Model Requirements M-F Eastern Business hours required Remote work requires stable, secure, compliant, quiet, work station, lockable drawer and Teams Video access requires via MGB provided equipment Meeting onsite optional. Must be able to share community based details and resources for local areas and surrounding areas (helping member locate resources in the area is key, local to MA, knowledge required) This fully remote position primarily serves enrollees enrolled in the One Care and Senior Care Options (SCO) programs, focusing on populations residing in Essex, Middlesex, Suffolk, Norfolk, Plymouth, Bristol, Dukes, and Nantucket counties. Responsibilities and caseload may be adjusted in response to changes in enrollee enrollment trends. Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.