Job Details

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 experience

License/Certification:

For Florida-Sunshine Health Plan - All interactions with members are done telephonically

Provides outreachto 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."

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 experience. Provides 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 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
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?

N-155353 - TEMP backfill for FTE, Chelsie Flinn, repurposing a Health Coach role for a CMSC II role for LHCC health plan expansion

Member facing
47+ calls a day (must hit at least 47 per day)
100% productivity Typical Day in the Role

• Daily schedule & OT expectations
• Typical task breakdown and rhythm
• Interaction level with team
• Work environment description

In this role one would contact eligible Medicaid members under a Centene health plan and offer them our Disease Management Health Coaching program. It is a role suited for those comfortable being on the phone and using a computer. Day 1 is getting the new hire up and running. The new hire would work with the Supervisor and preceptor to insure they have access to the required systems and programs. Day 1 would also cover expectations and some self-study on Centene University.

• Day 3 begins the new hires learning journey with our Training Department. The learning journey is around 3 weeks long and then the new hire begins to work on their own.

Working in cloud, classic, excel, teams and outlook
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

Candidate Requirements Education/Certification Required: i.e. High School diplom Preferred: Licensure Preferred:

• Years of experience required
• Disqualifiers
• Best vs. average
• Performance indicators

Must haves: Healthcare Customer service or call center experience, independent worker, Medicaid experience

Bilingual if possible
1-2yrs of healthcare/Medical call center experience
Disqualifiers: NEEDS MEDICAL HEALTHCARE EXPERIENCE

Performance indicators: We have a weekly productivity metric to meet. New hires receive 6 new hire call quality evaluations, done once per week. After moving on from new hire status, one receives 2 quarterly call quality evaluations.

Best vs. average:

• Top 3 must-have hard skills
• Level of experience with each
• Stack-ranked by importance
• Candidate Review & Selection

1 Microsoft office, 2 Computer skills, multi tasking skills, communication 3 RELIABLE INTERNET a must (work on hotspot if needed) Candidate Review & Selection

• Shortlisting process
• Second touchpoint for feedback
• Interview Information
• Onboard Process and Expectations

Projected HM Candidate Review Date: 24 hours of qual Number and Type of Interviews: 1 TEAMS CAMERA ON (professional environment and attire) Extra Interview Prep for Candidate: N Required Testing or Assessment (by Vendor): gencies, please perform computer literacy test (post as separate doc)