Description

POSITION SUMMARY

Responsible for the timely and quality completion of the Health Risk Assessment (HRA) for the Cal MediConnect (Medi-Cal/Medicare dual eligible) and Medi-Cal Seniors and Persons with Disabilities members. Demonstrates experience interacting in a positive manner with elderly and disabled populations. Demonstrates the ability to successfully complete surveys telephonically within strict timelines and completion rate standards. Communicate with case management team to coordinate needed care based on the completed HRA. Collaborate in a team environment and document activities timely and accurately.

COMPLIANCE WITH REGULATIONS

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS and DMHC.

RESPONSIBILITIES

• Places telephonic outreach to designated members to complete the Health Risk Assessment (HRA) upon enrollment and annually thereafter.
• Documents HRA outreach attempts in database, data enters HRA results in case management system, according to internal and compliance standards.
• Ensures confidentiality of all hard copy, electronic, and verbal communication, and adhere to all policies related to privacy and disclosure.
• Documents all member communications by entering a summary of the members concern, options offered for resolution, and any other relevant information into the identified systems.
• Listens and responds with empathy and outstanding customer service to members concerns. Takes action to meet or exceed member needs as well as HRA completion rates.
• Uses effective information gathering strategies that will help to improve the quality of services provided to members, such as obtaining better contact information for the member.
• Maintains product and company reputation and contributes to the team effort by conveying a professional image and accomplishing related tasks; participating on committees and in meetings; performing other duties as assigned or requested.
• Obtains sufficient information from members to assist and facilitate coordination of care and services. Works closely with the CHG staff to ensure member communicated information is transmitted timely, care and services are coordinated as directed, established protocols are followed, and that follow up is timely.
• Conducts or participates in the following activities: coordination and arrangement of care and services, including transportation and assistance with provider appointments, placement of monthly or quarterly status calls, and annual follow-up assessments.
• Works with Health Care Services, Customer Service, and providers to educate members on their health care options and services available through community-based organizations.
• Assists with entering critical points for care management into the appropriate information systems and communicates appropriate data with key staff to accomplish goals for care management plans.

• Contributes to the team effort by attending department meetings; giving and receiving
  feedback; accomplishing related results as needed; assisting clinical staff in identifying areas requiring policies and procedures; working with clinical staff in policy development and periodic policy review. Other duties as assigned

Qualifications

EDUCATION

• Bachelor’s degree or demonstration of active progress towards 4-year bachelor’s degree (in the field of psychology, sociology, public health, health education, health sciences, or related health field preferred). Equivalent of at least 60 semester units, or 90 quarter units completed towards bachelor’s degree.

 
EXPERIENCE/SKILLS

• 6 months customer service and data entry experience in medical field or related field, and/or
• 6 months customer service and data entry experience in a managed care organization preferred and/or
• 6 months in a sales or marketing role preferred.
• Ability to operate a personal computer, Microsoft Office, telephone, fax, and copier.
• Medical terminology.
• Excellent customer service and communication skills.
• Detail-oriented.
• Bilingual (English/Spanish) required.

PHYSICAL REQUIREMENTS

• Prolonged periods of (up to 100%) sitting while performing data entry and talking on telephone
• Periodic (up to 25%) standing and walking
• Occasional lifting (up to 25 lb.)
• May be required to work evenings and/or weekends.