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Description:
BASIC FUNCTION:
This position supports administrative care management duties including member and provider outreach, supporting healthcare initiatives and activities including educational and quality campaigns, assistance in scheduling care manager and member appointments, responding to member inquiries, data entry and research, supporting member non-clinical needs. This position may be responsible to manage low-risk members for health-related social needs, education, and basic member outreach screenings/inquiries.
ESSENTIAL FUNCTIONS:
Performs ongoing functions to support the Care Management Department, including one or more of the following:
Serve as the first line of contact for newly enrolled members by performing welcome calls, validation of service access and provision and linkage to care manager.
Perform outreach and follow up to members to support engagement in care and quality customer experience.
Perform health risk screenings and inform and educate members on the care management programs including benefits and community resources, using supplied scripts or training tools.
Complete records in system by performing data entry.
May include assistance in scheduling appointments, transportation or coordinating Provider outreach.
Generate appropriate correspondence and send to member manually or electronically.
Maintain production requirements based on established department business needs.
Provide support to the Care Management team by performing the non-clinical functions (as identified by the business process) necessary to support members healthcare needs and goals. This may include physical outreach to members via the Door Knocking procedure.
Maintain member non-clinical cases and documentation through outreach to support care plan goal progression and attainment, basic healthcare education material, and health initiatives, as applicable.
Receive, analyze, conduct research and respond to telephone and/or written inquiries. Process information from member or provider to determine needs/wants and ensure customer questions have been addressed. Respond to customer or send to appropriate internal party.
Perform data entry function to update customer or provider information.
Provide administrative functions for the care management team including mailings, answering incoming calls, call campaigns, data validation, data entry and communication with external government entities, as applicable.
Monitor the care management work queues and complete activities as directed.
Support member access to health-related social needs such as nutrition and housing along with state and health plan programs and benefits.
Comply with HIPAA, client Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
Maintain complete confidentiality of company related business.
Maintain effective communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
JOB REQUIREMENTS:
High school diploma or GED
1 year of college and 2 years experience with communication systems including Fax, Email and Telephone
1 year experience with managed care system(s) or healthcare systems (i.e.; hospital ,doctor office, community based organization).
Experience coordinating member needs, providing assistance to members, and analyzing member needs.
Basic knowledge of medical or healthcare terminology.
Knowledge of clinical systems (claims, enrollment, documentation).
PC proficiency including Microsoft Office applications.
Customer service skills.
Verbal and written communications skills including developing written correspondence to internal and external stakeholders.
PREFERRED JOB REQUIREMENTS:
College courses in medical field, human services, social work, psychology or related healthcare field
Notes:
Contract to Hire
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status