Job Details

Position Purpose:
Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities.

Education/Experience:
Requires a High School diploma or GED
Requires 1 - 2 years of related experience

License/Certification:

For Florida-Sunshine Health Plan - All interactions with members aredone telephonically.
For Arkansas Total Care plan - This position is designated as safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment check (before hire and recurring), and a drug screen (at time of hire and recurring). Must reside in AR or border city. Travel: 30%. required" "Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate

Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed

Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan

Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service

May support performing service assessments/screenings for members and documenting the member's care needs

Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed

Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards

Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager

Provide education on benefits and resources available
Performs other duties as assigned.

Complies with all policies and standards.

EEO:

"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."

Story Behind the Need

• What is the purpose of this team?
• Describe the surrounding team (team culture, work environment, etc.) & key projects.
• Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?

Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically and documents the plan for care/services of activities.

Member & provider facing

Mainly outbound calls but will have a small portion from inbound que

**Cameras on during meetings Typical Day in the Role

• Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
• What are performance expectations/metrics?
• What makes this role unique?

Making outbound calls to members to complete assessments, provide benefit education and resources, offer Care Management services.
This position does receive inbound calls from a phone queue but the majority of calls are outbound from a caseload. Ability to use one call resolution for inbound calls.
Metrics: Average calls per day is 20-24 with a 30% success rate. Case load between 400 & 500 cases with outreaches primarily made every 12 weeks. Candidate Requirements Education/Certification Required: High School Diploma/GED Preferred: Licensure Required: none Preferred: Years of experience required: 1-2 years of experience in remote phone work medical field related. Call center experience/managed care organization experience, medical office experience, tech savvy is a must , position longevity

Bonus would be foster care experience , bilingual,

Disqualifiers: job hopping (please state if contract and if they completed the contract)

dditional qualities to look for: Ability to talk and type concurrently, self driven

• Top 3 must-have hard skills stack-ranked by importance

1 bility to communicate with team and members efficiently and appropriately 2 bility to prioritize and work independently, ability adapt to change 3 bility to type and text concurrently, tech savvy is a must Candidate Review & Selection

• Shortlisting process
• Candidate review & selection
• Interview information
• Onboard process and expectations

Projected Manager Candidate Review Date: 24 / 48 hours
Type of Interviews:
Teams CAMERA ON Required Testing or Assessment (by Vendor): gencies perform

Computer literacy - Microsoft office

Typing test - 45 WP - 95% Next Steps