Member Care Specialist
DIRECTION HOME AKRON CANTON AREA AG
Function(s):
Provide information and assistance to members, caregivers, providers and other stakeholders in support of the HCBS Division.
JOB RESPONSIBILITIES:
Member Communication & Support
Perform any other job-related instructions as requested Required:
At least 2 years college education
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.
Perform any other job-related instructions as requested Required:
- 1 year of experience in Customer Service or related position
- High school diploma
- Basic typing and/or data entry skills
- MS Office skills-intermediate or better
- Good organizational skills
At least 2 years college education
Vacancy posted 4 days ago
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