Member Care Specialist

JOB RESPONSIBILITIES:

1. Handle incoming emergent communication requests from members, providers, payors and others pertaining to individuals served by Care Managers, Waiver Service Coordinators, Nurse Transition Coaches and other clinical care professionals, including but not limited to phone calls, census data management, member transfers, service increase and decrease requests, resource requests, reports and more. 
2. Document the stakeholder requests in the appropriate documentation systems in a timely and accurate manner.
3. Communicate with members by phone or at times in-person with compassion utilizing effective motivational interviewing and at times and effective sales technique; be familiar with Health Plan offerings and communicate the requests to the assigned Care Manager/WSC and Nurse Transitions Coach.
4. As needed, schedule home visits for Field Staff according to Program requirements. Document calls/contacts/closeouts/enrollments accordingly in ClientTrack.
5. If handling incoming CM/WSC related calls consult with the covering Licensed Coverage Care Specialist as needed for all clinical issues. Also, consult with the Supervisor and/or program Director as needed when addressing clinical issues.  
6. Facilitate and coordinate services based upon the care plan with all stakeholders.
7. When appropriate, enter census into ClientTrack database, conduct research to track facility-based members.
8. Maintain appropriate documentation within protocols and guidelines for all HCBS programs.
9. As needed, distribute and track satisfaction surveys and Scorecards.
10. Retrieve and follow-up on voicemails for absent clinical program staff.
11. Assist clinical program staff and members in the services referral process.
12. Monitor UM alerts (admissions/discharges) for the MyCare Ohio CareSource program.
13. Complete visits as needed for the Program that do not require licensure, both in the facility and/or home setting.
14. Perform any other job-related instructions as requested.

1. Identify and implement LEAN process engineering activities.
2. Participate in the development and implementation of the local performance culture.
3. Exemplify the Agency 3C’s corporate culture in all activities and interactions with staff, members, consumers, stakeholders as well as the community at large.
4. Maintain minimum proficiency in all requisite computer applications and software.
5. Participate in the implementation of strategic business and/ or operational plans, projects, programs and systems as appropriate for the objectives.
6. Participate in and contribute towards accomplishment of divisional and Agency dashboard goals.

Perform other tasks as assigned by supervisor

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 : $44,600 - $53,800