This position is forCare1st Health Planin Phoenix, a WellCare Healthplans, Inc. company.
Conducts telephonic, mail and in-person outreach to members who are identified as requiring outreach services in support of clinical quality initiatives and regulatory/contractual requirements. Provides assistance to clinical compliance staff with member education classes, health promotion initiatives and performance data collection and recording. Works with individuals and/or families in a field setting and interacts with a variety of health care providers, external support agencies and county departments. Works in the community making home visits, as well as visits community facilities to conduct health education activities focusing on current members. May conduct specialty clinics on health education where necessary. Clients typically have limited knowledge of health principles, nutrition, disease process, appropriate care or available resources.
Department:Health Services-Quality Improvement
Reports to: Mgr, Quality Improvement
Location: Camelback Rd, Phoenix AZ 85016
Job Type: Hourly/Non-exempt
- Conducts telephonic, mail and in person outreach to members, providers and community organizations to support Utilization Management, Case Management and/or Quality Improvement regulatory & contractual metrics and requirements. (e.g., compliance with state required programs such as the EPSDT program, appropriate ER utilization etc.).
- Provides members with information on how to access preventive and health maintenance services while identifying barriers to care.
- Promotes and distributes educational material and benefit plan information to members.
- Assists members in making follow-up appointments with his/her Primary Care Physician (PCP) and/or Specialist to access needed health services and fill the gap in care.
- Provides telephone follow-up to ensure members have seen their PCP and are completing their treatment plan or preventive care services as defined by the PCP or guidelines. Provides follow-up and resolution in response to the Member Intervention Forms received from the PCP.
- Develops and maintains relationships with external support agencies and health care providers so that members have easy access to information on plan benefits.
- Visits community facilities to conduct health education activities focusing on current members. May conduct specialty clinics on health education where necessary. (This function may vary by state)
- Assists Community Relations/Community Outreach with events, presentations and/or maintaining relationships with community stakeholders regarding communication on plan benefits to current members. (This function may vary by state)
- Performs other duties as assigned.
- In some states this role is done 100% telephonic and does require travel outside of the office.
- Required A High School or GED
- Preferred An Associate's Degree or a Bachelor's Degree in a related field
- Required 1 year of experience in member outreach in a healthcare/community center environment
- Preferred Experience in managed care
- Required Community awareness and knowledge
- Preferred Experience having been a Medicaid recipient
- Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Some understanding of medical terminology
- Advanced Demonstrated written communication skills
- Advanced Demonstrated interpersonal/verbal communication skills
- Intermediate Ability to multi-task
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Other Appreciation of cultural diversity and sensitivity towards targeted populations
- Intermediate Other Ability to communicate effectively with people with varying levels of education
- Intermediate Other Ability to arrange their own work day
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Excel
- Required Intermediate Other Database management