Medical Management Representative

MISSION
Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES
HealthOne is guided by a cultural framework that embodies our values and drives our decisions.


Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSE
The Medical Management Representative supports clinical team and serves as a proactive resource for members related to case management and utilization management.

ESSENTIAL JOB DUTIES
Conducts educational telephone calls advising members of available benefits, services and programs; refers members to population health management programs as appropriate
Reaches out to members with identified gaps in care to provide assistance in securing provider(s) and arranging appointment(s)
Manages system work queues; screening identified members for eligibility, prior case activities, recent claims, customer service inquiries and authorization history; assigning members to clinical team for call outreach and intervention
Facilitates research and analysis of inquiries and/or complaints and other program related inquiries
Functions as a liaison to clinical staff
Collects and enters data as appropriate to process prior authorization requests
Participates in projects as needed
Performs duties such as, but not limited to, project research, data entry, and file management
Works with internal and external persons and/or entities to ensure requests, problems and questions are researched and resolved in a timely manner
Works overtime as needed
Regular and predictable attendance
Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
Works to encourage and promote Company culture throughout the organization - waiting on this to be approved
Other duties as may be assigned

QUALIFICATIONS
High School diploma or its equivalent
Experience in a customer service role is preferred
Proficient in Microsoft Office (Outlook, Word, Excel)
Fundamentals of Nursing or its equivalent
Working knowledge of NCQA preferred
Must be able to work in an independent and creative manner
Ability to manage multiple projects and priorities
Adaptive to high pace and changing environment
Proficient in interpreting benefits and contract language
Knowledge of medical terminology

PHYSICAL REQUIREMENTS
Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

BENEFITS
401K (4% Match, Immediate Vesting)
Accident insurance
Competitive salary
Critical Illness Insurance
Dental Insurance
Employee Assistance Program
Flexible Spending Account
Health & Wellness Program
Health Savings Account
Life & AD&D Insurance
Long Term Disability
Medical Insurance
Paid Time Off
Pet Insurance
Short Term Disability
Vision Insurance


PRE-EMPLOYMENT SCREENING
Drug Screen and Background Check Required

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status or any other status protected by state or federal law.