Job Title : Member Care Coordinator

Job Location : Remote Field Visits in Springfield IL.

Job Duration : 6 months with possible extension.

Shift : 8 : 00 AM to 5 : 00 PM Monday Friday.

Job Description

• Responsible for home health assessments and system updates.
• Perform outreach and follow up attempts to members on their health care plan.
• Build relationships with members to encourage compliance with care plans and to alert the Case Manager quickly when issues arise.
• 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.
• Conduct check-ins with members to review individual care plan goals.
• Maintain production requirements based on established department business needs.
• 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.
• 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.
• Notify help desk of system issues.
• Perform data entry function to update customer or provider information.
• Obtain required or missing information via correspondence or telephone.
• 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.
• Support and maintain communications with various in-house areas regarding groups? concerns, i.e. : Marketing, Provider Affairs, and SSD.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

Last updated : 2024-05-30