Member Care Coordinator
Company: VIVA USA Inc
Location: Downers Grove
Posted on: June 25, 2022
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Job Description:
Description: BASIC FUNCTION: This position is responsible for
conducting home health assessment, contacting identified members to
inform and educate them on health care programs to address their
personal health plan needs, engaging the member in discussion of
adherence to personal health plans, responding to inquiries from
members, and supporting the clinicians in the Medical Management
department with their provider and member activities. ESSENTIAL
FUNCTIONS: 1. Responsible for home health assessments and system
updates. 2. Perform outreach and follow up attempts to members on
their health care plan. 3. Build relationships with members to
encourage compliance with care plans and to alert the Case Manager
quickly when issues arise. 4. Inform and educate members on their
program, may use supplied scripts. Complete records in system by
performing data entry. Encourage member usage of our programs,
including arranging appointments and additional member services
(e.g., transportation). Generate appropriate correspondence and
send to member manually, electronically, or telephonically. 5.
Conduct check-ins with members to review individual care plan
goals. 6. Maintain production requirements based on established
department business needs. 7. Provide support to the clinical team
by performing the non-clinical functions (as identified by the
business process) necessary to generate, manage, and close a case
within the platform. 8. Receive, analyze, conduct research and
respond to telephone and/or written inquiries. Process information
from member or provider to determine needs/wants and ensure
customer questions have been addressed. Respond to customer or send
to appropriate internal party. 9. Notify help desk of system
issues. 10. Perform data entry function to update customer or
provider information. 11. Obtain required or missing information
via correspondence or telephone. 12. May serve as contact for the
various groups regarding claims which involves conducting research,
obtaining medical records/letters of medical necessity from TMG,
reopen or initiate new cases as needed and refer case to
clinicians. 13. Support and maintain communications with various
in-house areas regarding groups' concerns, i.e.: Marketing,
Provider Affairs, and SSD. 14. Communicate and interact effectively
and professionally with co-workers, management, customers, etc. 15.
Comply with HIPAA, Diversity Principles, Corporate Integrity,
Compliance Program policies and other applicable corporate and
departmental policies. 16. Maintain complete confidentiality of
company business. 17. Maintain communication with management
regarding development within areas of assigned responsibilities and
perform special projects as required or requested. JOB
REQUIREMENTS: Bachelor of Social Work or Psychology OR LVN, LPN
with 1 year experience in managed care systems OR RN OR 3 years
care coordination for a state managed or waiver program OR 3 years
managed care systems experience. Knowledge of medical terminology
Experience coordinating member medical related needs, providing
assistance to members, and analyzing member needs PC proficiency
including Microsoft Office applications Customer service skills
Verbal and written communications skills including developing
written correspondence to members and to other department personnel
and coaching skills, including motivational interviewing, to
educate members on medical issues Current state driver license,
transportation, and applicable insurance Ability and willingness to
travel. Required Qualification(s) ESSENTIAL FUNCTIONS: Responsible
for home health assessments and system updates. VIVA is an equal
opportunity employer. All qualified applicants have an equal
opportunity for placement, and all employees have an equal
opportunity to develop on the job. This means that VIVA will not
discriminate against any employee or qualified applicant on the
basis of race, color, religion, sex, sexual orientation, gender
identity, national origin, disability or protected veteran
status.
Keywords: VIVA USA Inc, Downers Grove , Member Care Coordinator, Other , Downers Grove, Illinois
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