This position is forCare1st Health Plan in Phoenix, AZ, a WellCare Healthplans, Inc. company.
Conducts telephonic outreach to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements. Provides education to members regarding the care gaps they have. Assists in scheduling doctor appointments via three-way phone calls and assists in scheduling transportation services, if needed. Maintains confidentiality of business and protected health information.
Department:Arizona-Health Services Quality Improvement
Reports to: Mgr, Quality Improvement
Location: E Camelback Rd, Phoenix AZ 85016
Job Type: Hourly/Non-exempt
- Conducts telephonic outreach to members to support Quality Improvement, regulatory and contractual requirements.
- Educates the member and their family about preventive health screenings while identifying barriers to care.
- Schedules doctor appointments for all household members with care gaps with the Primary Care Physician (PCP) and/or Specialist to access needed preventive care services and close gaps in care via a three-way phone call.
- Informs providers about the care gap(s) member has and why they are seeing the provider.
- Arranges transportation for members as needed.
- Documents all actions taken regarding contact related to member.
- Interacts with other departments including Customer Service to resolve member issues.
- Refers to CM/DM as appropriate.
- Completes special assignments and projects instrumental to the function of the department.
- Performs other duties as assigned.
- High School Diploma.
- Associate's Degree or Bachelor's Degree strongly preferred
- 1-2 years' experience in member, provider and customer service or call center environment.
- Some understanding of medical terminology.
- Appreciation of cultural diversity and sensitivity towards targeted populations.
- Health coaching experience a plus.
- Experience in managed care helpful.
Special Skills (e.g. 2nd language):
- Bilingual skills (English and Spanish) a plus.
- Excellent communication skills required.
- Data Entry skills
- Ability to communicate effectively and professionally with members and providers.
Proficient in Microsoft Office (Word, Excel).