Position Purpose:
Supports administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines.
Education/Experience:
Requires a High School diploma or GED
Requires 1 - 2 years of related experienceProvides outreach to members via phone to support with care plan next steps, community or health plan resources, questions or concerns related to scheduling and ongoing education for both the member and provider throughout care/service
Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service
May apply working knowledge of assigned health plan(s) activities and resources
Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures, and protocols
Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship
Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed
Knowledge of existing benefits and resources locally and make referrals to address Social Determinants of Health (SDOH) needs
Performs other duties as assigned
Complies with all policies and standards
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Story Behind the Need - Business Group & Key Projects
- Health plan or business unit
- Team culture
- Surrounding team & key projects
- Purpose of this team
- Reason for the request
- Motivators for this need
- ny additional upcoming hiring needs?
- We are part of Care Management, Shared Services, Medicare
- Purpose of the Team is to make outbound calls daily to remind members about Care Gaps ie preventative visits and to complete the Health Risk Assessment if it is due.
- Reason for the request - temp backfill for Yosbel Sanjudo.
- Daily schedule & OT expectations
- Typical task breakdown and rhythm
- Interaction level with team
- Work environment description
- SCs are assigned at least 30 members daily to outreach, SC will do 1 call attempt per day to # listed for member. If # is invalid SC will also make a call attempt to PCP to attempt to get a valid #. If member is reached PCP will review CareGaps with member, go over Health Risk Assessment if needed, offer to assist with scheduling appointment and confirm member has no other questions/needs. SC will continue to call member four more times, four different times of day if member is not reached on the first outreach.
- 30 new members per day, 125 per week and 600 per month
- udit score of 90% or better
- Meet 10 day TAT
- Use proper note documentation
- 80-100 Calls per day
- What makes this role interesting?
- Points about team culture
- Competitive market comparison
- Unique selling points
- Value added or experience gained
- We outreach Medicare members, mostly those who are over 65 or have Medicare due to health issues
- Supportive Team culture with daily chat, monthly online meetings and consistent goals and feedback
- Great entry-level job with opportunities to move up for motivated individuals after 1 year as a full-time employee
- Years of experience required
- Disqualifiers
- Best vs. average
- Performance indicators
Nice to haves: N/
Disqualifiers: Management has requested no CA candidates
Performance indicators:
- 30 new members per day, 125 per week and 600 per month
• Meet 10 day TAT
• Use proper note documentation
• 80-100 Calls per day
Best vs. average: Best- see above
- Top 3 must-have hard skills
- Level of experience with each
- Stack-ranked by importance
- Candidate Review & Selection
- Shortlisting process
- Second touchpoint for feedback
- Interview Information
- Onboard Process and Expectations
- Background Check Requirements (List DFPS or other specialty checks here)
- Do you have any upcoming PTO?