What are the responsibilities and job description for the Member Care Specialist position at DIRECTION HOME AKRON CANTON AREA AG?
Function(s):
Provide information and assistance to members, caregivers, providers and other stakeholders in support of the HCBS Division.
JOB RESPONSIBILITIES:
Member Communication & Support
Serve as the primary point of contact for urgent communications from members, providers, payors, and other stakeholders regarding members served by clinical care management staff, ensuring timely triage, resolution, and escalation as appropriate.
When responding to Care Manager or Waiver Service Coordinator-related inquiries involving clinical issues, consult with licensed coverage staff and escalate concerns to the Supervisor and/or Program Director as appropriate.
Provide administrative, operational, and claims review support for care management programs including but not limited to:
Managing phone calls and voicemail follow-up for absent clinical program staff
Coordinating member visits and scheduling in accordance with program requirements
Maintaining census data, assignments, tracking, and reconciliation
Processing service referrals and resource requests
Conducting claims reviews and related research
Reconciling reports and ensuring data accuracy
Completing Transitions of Care follow-up activities, including hospital admission and discharge monitoring
Engage and communicate with members by phone utilizing motivational interviewing, customer service, and effective sales techniques to promote participation in health plan programs and services and communicate identified needs and requests to the assigned Care Manager/WSC, Nurse Transitions Coach, or appropriate clinical staff.
Document requests in the appropriate documentation systems in accordance with protocols and guidelines for all HCBS programs.
Complete visits as needed for the Program that do not require licensure, both in the facility and/or home setting.
Perform any other job-related instructions as requested
Qualifications:
Required:
1 year of experience in Customer Service or related position
High school diploma
Preferred:
Basic typing and/or data entry skills
MS Office skills-intermediate or better
Good organizational skills
At least 2 years college education
Salary : $46,000 - $55,500
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