Member Care Specialist

Member Care Specialist

GREEN - UNIONTOWN, OH 44685

Overview

Salary Range $46,000.00 - $55,500.00 Salary/year Position Type Full Time

Description

Function(s): Provide information and assistance to members, caregivers, providers and other stakeholders in support of the HCBS Division.

Job Responsibilities: Member Communication & Support

Serve as the primary point of contact for urgent communications from members, providers, payors, and other stakeholders regarding members served by clinical care management staff, ensuring timely triage, resolution, and escalation as appropriate.

When responding to Care Manager or Waiver Service Coordinator-related inquiries involving clinical issues, consult with licensed coverage staff and escalate concerns to the Supervisor and/or Program Director as appropriate.

Provide administrative, operational, and claims review support for care management programs including but not limited to:

• Managing phone calls and voicemail follow-up for absent clinical program staff
• Coordinating member visits and scheduling in accordance with program requirements
• Maintaining census data, assignments, tracking, and reconciliation
• Processing service referrals and resource requests
• Conducting claims reviews and related research
• Reconciling reports and ensuring data accuracy
• Completing Transitions of Care follow-up activities, including hospital admission and discharge monitoring
• Engage and communicate with members by phone utilizing motivational interviewing, customer service, and effective sales techniques to promote participation in health plan programs and services and communicate identified needs and requests to the assigned Care Manager/WSC, Nurse Transitions Coach, or appropriate clinical staff.
• Document requests in the appropriate documentation systems in accordance with protocols and guidelines for all HCBS programs.
• Complete visits as needed for the Program that do not require licensure, both in the facility and/or home setting.

Qualifications

Required:

• 1 year of experience in Customer Service or related position
• High school diploma

Preferred:

• Basic typing and/or data entry skills
• MS Office skills-intermediate or better
• Good organizational skills

At least 2 years college education