Mindlance
General Information
Job Description: Job Profile Summary
Position Purpose:
Works with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction with members and providers at large IPA and/or group practices. Serves to collaborate with providers in the field, to improve HEDIS measures and provides education for HEDIS measures and coding. Supports the implementation of quality improvement interventions and audits in relation to plan providers. Assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS. Conducts telephonic outreach, while embedded in the providers' offices, to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements. Provides education to members regarding the care gaps they have when in the providers office for medical appointments. Schedules doctor appointments on behalf of the practitioner and assists member with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available. Maintains confidentiality of business and protected health information.
Education/Experience: Required: a Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or equivalent work experience required (a total of 4 years of experience required for the position); work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment. 2+ years of experience work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.
License/Certification: One of the following is preferred. Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN) preferred.
Responsibilities Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
Acts as the face of WellCare in the provider community with the provider and office staff where their services are embedded.
Advises and educates Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.
Assesses provider performance data to identify and strategizes opportunities for provider improvement.
Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters).
Schedules doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider's office.
Conducts face-to-face education with the member and their family, in the provider's office, about care gaps identified, and barriers to care.
Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements.
Arranges transportation and follow-up appointments for member as needed.
Documents all actions taken regarding contact related to member.
Interacts with other departments including customer service to resolve member issues.
Refers to case or disease management as appropriate.
Completes special assignments and projects instrumental to the function of the department. Performs other duties as assigned
Complies with all policies and standards
Centene Job Description 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? Health Plan, newer team going through a lot of changes and opening the role to reach out to Medicaid members in partnership with PCP offices to close specific CCO and HPRS care gaps We are a newer team that's diverse, collaborative, very communicative, and treats the department as a quality family. All hands-on deck to ensure the job gets done. FTE backfill needed N/ Typical Day in the Role
Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description 8 hour work day, 40 hours/week, no OT planned, regular team interaction and coordination and potential for travel in state to members or events We meet virtually as a team several times a week; we work collaboratively to complete projects; and utilize Ims and emails to communicate throughout the day to ensure we get things done timely and completed We are Medicaid-specific and we take pride in reaching out to our most vulnerable members to ensure proper resources Compelling Story & Candidate Value Proposition
What makes this role interesting? Points about team culture Competitive market comparison Unique selling points Value added or experience gained New role, member facing, helping members get the quality care they deserve (See above) N/ N/ (See above) Candidate Requirements
Education/Certification
Required: (a Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or equivalent work experience required (a total of 4 years of experience required for the position); work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment. 2+ years of experience work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.) Preferred: Will take RN/LPN with 4 years' experience in lieu of bachelor's degree. (can have Associate's degree)
Licensure
Required: Preferred: RN, LPN
Years of experience required Disqualifiers Best vs. average Performance indicators Must haves: clinical
Nice to haves: HEDIS
Disqualifiers: If no clinical experience
Performance indicators: ensuring the members' needs are being met
Best vs. average:
Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection 1 Patient member-facing experience 2 Someone who's worked with insurance/in medical office 3
Candidate Review & Selection
Shortlisting process Second touchpoint for feedback Interview Information Onboard Process and Expectations Projected HM Candidate Review Date: 2 business days after receiving resumes Number and Type of Interviews: 1 st round panel interview with hiring manage and peer, 2 nd round with leadership, VP and/or Director Extra Interview Prep for Candidate: N/ Required Testing or Assessment (by Vendor): N/
Manager Communication Preferences & Next Steps
Background Check Requirements (List DFPS or other specialty checks here) Do you have any upcoming PTO? 7/21
Colleagues to cc/delegate Cheryl Yook
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Education/Experience: Required: a Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or equivalent work experience required (a total of 4 years of experience required for the position); work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment. 2+ years of experience work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.
License/Certification: One of the following is preferred. Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN) preferred.
Responsibilities Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
Acts as the face of WellCare in the provider community with the provider and office staff where their services are embedded.
Advises and educates Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.
Assesses provider performance data to identify and strategizes opportunities for provider improvement.
Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters).
Schedules doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider's office.
Conducts face-to-face education with the member and their family, in the provider's office, about care gaps identified, and barriers to care.
Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements.
Arranges transportation and follow-up appointments for member as needed.
Documents all actions taken regarding contact related to member.
Interacts with other departments including customer service to resolve member issues.
Refers to case or disease management as appropriate.
Completes special assignments and projects instrumental to the function of the department. Performs other duties as assigned
Complies with all policies and standards
Centene Job Description 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? Health Plan, newer team going through a lot of changes and opening the role to reach out to Medicaid members in partnership with PCP offices to close specific CCO and HPRS care gaps We are a newer team that's diverse, collaborative, very communicative, and treats the department as a quality family. All hands-on deck to ensure the job gets done. FTE backfill needed N/ Typical Day in the Role
Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description 8 hour work day, 40 hours/week, no OT planned, regular team interaction and coordination and potential for travel in state to members or events We meet virtually as a team several times a week; we work collaboratively to complete projects; and utilize Ims and emails to communicate throughout the day to ensure we get things done timely and completed We are Medicaid-specific and we take pride in reaching out to our most vulnerable members to ensure proper resources Compelling Story & Candidate Value Proposition
What makes this role interesting? Points about team culture Competitive market comparison Unique selling points Value added or experience gained New role, member facing, helping members get the quality care they deserve (See above) N/ N/ (See above) Candidate Requirements
Education/Certification
Required: (a Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or equivalent work experience required (a total of 4 years of experience required for the position); work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment. 2+ years of experience work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.) Preferred: Will take RN/LPN with 4 years' experience in lieu of bachelor's degree. (can have Associate's degree)
Licensure
Required: Preferred: RN, LPN
Years of experience required Disqualifiers Best vs. average Performance indicators Must haves: clinical
Nice to haves: HEDIS
Disqualifiers: If no clinical experience
Performance indicators: ensuring the members' needs are being met
Best vs. average:
Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection 1 Patient member-facing experience 2 Someone who's worked with insurance/in medical office 3
Candidate Review & Selection
Shortlisting process Second touchpoint for feedback Interview Information Onboard Process and Expectations Projected HM Candidate Review Date: 2 business days after receiving resumes Number and Type of Interviews: 1 st round panel interview with hiring manage and peer, 2 nd round with leadership, VP and/or Director Extra Interview Prep for Candidate: N/ Required Testing or Assessment (by Vendor): N/
Manager Communication Preferences & Next Steps
Background Check Requirements (List DFPS or other specialty checks here) Do you have any upcoming PTO? 7/21
Colleagues to cc/delegate Cheryl Yook
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."