Remote role!

Responsibilities:

• Receives incoming calls from members emanating from quality outreach initiatives such as mailings, emails, phone calls, etc.
• Makes outgoing calls to educate members on the importance of closing gaps in care such as appropriate testing, periodical checkups, immunizations, counseling and provide health education materials.
• Maintain accurate member records from outreaches such as incoming calls, successful outreaches, member issues, and member roadblocks.
• Act as a liaison with providers, members and outside community resources by assisting with scheduling an appointment, warm transfers to member services, etc.
• Assure understanding level of each member by providing clear and complete information in accordance with company guidelines.
• Administer Rewards and Incentive programs for both Medicaid and Medicare members by sending out rewards, confirm member demographics, and educate members in regards to the R&I Program.
• Refer members to a Clinical Quality nurses as necessary.
• The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.

Qualifications:

Education/Experience:

• Requires an Associates degree from an accredited college or university, preferably in healthcare field. In lieu of degree applicant must have 3 years of equivalent and relevant work experience.
• Requires 2 years work experience in case management, community health, Medicaid or health insurance environment.
• Requires a minimum of 2 years experience working with members to close gaps in care.
• Requires a minimum of 1 year managed care experience.