Member Services Coordinator

Member Services Coordinator

Position Type: Temporary

Schedule: M-F, 8:00 am - 5:00 pm; Remote (Candidate must reside in Southern California)

Assignment Length: Approximately 6-Months, possibly longer.

Description

Under the supervision of the Manager, Integrated Care Management, the Member Services Coordinator is responsible for working as the liaison for all incoming referrals for Enhanced Care Management (ECM) members. This position focuses on member outreach, engagement, screening, referral coordination, and documentation. The Member Services Coordinator connects members with appropriate community-based care management services based on their individual needs and eligibility. The role involves communicating with members, healthcare providers, internal departments, and community organizations through phone, email, text, and other communication methods. The ideal candidate is organized, patient, comfortable speaking with people from diverse backgrounds, and able to effectively manage multiple priorities while providing a positive member experience.

Key Responsibilities

Act as a subject matter expert resource for internal and external contacts supporting all Health Care Organizations. This includes:

• Assist Enhanced Care Management leadership with operational tasks, telephonic functions, projects, tracking, and trending.
• Facilitate communication between internal departments and external entities.
• Support Coordinators on Model 2 CBCME teams needing assistance.
• Provide training/precepting for new staff to the Health Plan and Enhanced Care Management processes and operations.

Assist leadership with data collection, including Team Member metrics and process improvement initiatives

Work as part of a multidisciplinary team to ensure coordinated and continuous care of members

Perform initial outreach and engagement to Enhanced Care Management eligible members who have not been attributed to an Enhanced Care Management team.

Identify the appropriate Community Based-Care Management Entities (CB-CME) for the member.

Model the highest ethical behavior in relationships with co-workers, supervisors, members, Providers, and colleagues in the community.

Promote a collaborative and effective working environment within the Enhanced Care Management team by engaging in evidence-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on member case discussions.

Build and maintain positive working relationships with Providers, including, but not limited to, communication via in-person, over the phone, and through digital means such as email and fax.

Engage with members by letter, email, texts, and telephone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the member and their medical/behavioral team, as well as to increase the member's sense of control over their whole health.

Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as identifying and addressing HEDIS gaps, and by identifying, developing, and testing new practices for improving the outcomes of the Enhanced Care Management team.

Assist with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.

Ensure documentation is accurate and in compliance with regulatory requirements and accreditation standards.

Participate in Health Plan staff meetings or other activities as needed.

Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Requirements

• Two (2) years of customer service experience in any setting required
• Experience of successfully working within a team
• Experience in data entry
• Internal Candidate qualifications are:
• Not on a Performance Improvement Plan (PIP)
• Promotes an objective and collaborative working environment within their team
• Supports management in reaching department and Health Plan goals
• High School diploma or GED required