Job Description :
This job is responsible for serving as a liaison between the member, the Health Plan, and the provider for the Highmark Delaware Medicaid product. The position conducts telephonic support to assess member needs, provide appointment scheduling assistance, and educating members of their rights and responsibilities. This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and externally.
1. Communicate effectively with staff, providers and members to accomplish business and member needs
2. Initiate outreach efforts, primarily by telephone, related to targeted preventive health initiatives:
- Perform member education functions on the importance of targeted preventive health services
- Recruit, holistically assess and enroll members into Disease Management Programs as appropriate
- Assess opportunity for Care Management intervention and make appropriate referral
- Contact members, providers and community agencies to coordinate access to preventive health services
- Tracks all member and provider contacts in the appropriate computer systems for the purposes of data collection and record keeping
3. Conducts provider and community trainings on EPSDT services and other special preventive health initiatives
4. Contribute to the development and preparation of educational materials for members and providers
5. Collaborates with human services providers such as Head Start Programs, WIC and homeless shelters; as well as state agencies such as CYS and Juvenile Probation in the identification and outreach to members in need of services.
6. Participate in the development of outreach programs that are effective, measurable and innovative, with a special emphasis on reaching at risk members.
7. Maintain community repository by validating existing information, adding/deleting resources.
8. Assumes leadership and responsibility for selected projects
9. Other duties as assigned or requested.
- 1 year in Community Outreach or Customer Service
- Familiarity as a Member Advocate or with complaint and grievance processes
- Familiarity with Delaware Medicaid and the Medicaid LTSS benefit package
- Must be proactive, self-directed, assertive and creative in problem solving and system planning
- Strong active listening skills with the ability to act sensitively toward diverse people and situations .Ability to successfully interact with external customers, peers, colleagues, and management team
- Demonstrate effective time management skills and demonstrate an ability to prioritize and handle multiple tasks simultaneously
- Must demonstrate sound judgment and discretion when approaching problems and making decisions
- This position must be able to utilize sound and flexible productive work habits to set priorities, organize work and utilize time effectively
- Must be aware of issues Gateway Health Plan members face related to healthcare including transportation, child care, lack of knowledge concerning Preventive Health, distrust of the system as well as other personal, social, financial barriers
- Must demonstrate patience and empathy when interacting with members and all internal/external customers
- This job requires the ability to work independently and as a team member
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Referral Bonus: Level 1
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