Member Care Ambassador

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.

WORK CULTURE

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

• Integrity

• Accountability

• Collaboration

• Trust

• Respect

Disclaimers:

• Flexible work schedule is based on job duties, department, organization, or business need.

• Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The GCHP Member Care Ambassador is responsible for leading activities to achieve a superior member experience and improve health outcomes measured by MCAS and CAHPS scores. This is done by supporting member outreach projects, marketing initiatives, health fairs, closing quality care gaps, being a member of the ICT team, supporting members address social drivers of health, community activities, conducting new member benefits orientations, member retention activities, vendor outreach and supporting providers at their clinic sites to answer questions that may arise and link them to the appropriate GCHP team member. The Member Care Ambassador will be embedded in several community locations such as provider sites, administrative offices, community centers, GCHP Resource Centers and school wellness centers aimed at identifying and addressing member needs.

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Work Schedule:

Travel to multiple sites and locations. Work protracted and irregular hours and evening meetings or work irregular hours (including some weekends) for attendance at meetings for special projects and programs.

Amount of Travel Required: 25-50%

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

• Serves as GCHP community liaison for Members and potential Members through Outreach, Community Events, School Wellness Centers, GCHP Member Hubs and at provider clinics with the purpose of identifying and supporting to address member needs.

• Interacts face-to-face with members at provide sites, community centers, School Wellness Centers, and GCHP Resource Centers.

• Works closely with the Operations, Health Services, and Policy and Programs teams to refer and triage appropriately to these teams regarding escalated member issues.

• Works in collaboration with the Community Relations team to plan, develop, implement, and organize events and volunteers to advance the mission and goals of GCHP at their community location.

• Develops and maintain business relationships and information that will result in opportunities to increase membership/enrollment targets at their community location.

• Provides accurate information about eligibility, benefits and claim status and authorization requirements to serve members in a courteous and professional manner.

• When appropriate serves as a member of the Integrated Care Team to support member needs. Supports in conducting member assessments as well as contributing to the member care plan under the guidance of a nurse and social work staff. Can also participate in the member’s clinic visit when appropriate.

• Represents the department at internal and external meetings including, but not limited to, vendor reporting, departmental, cross-functional, community, provider, etc.

• Develops presentations including, but not limited to, member retention meetings, new member advocacy, outreach activities, etc.

• Provides assistance with member-oriented events.

• Maintains strict confidentiality of all sensitive information.

• Escalates unresolved issues to the next level and/or appropriate area when necessary and timely.

• Assists members with their Medi-Cal renewal process when appropriate or refers members to the appropriate community partner to support eligibility questions / needs.

• Assist members with contacting their Medi-Cal case worker regarding eligibility issues or changes to their demographic information.

• Performs member outreach calls to enforce member retention.

• Applies surveys to obtain member feedback.

• Assist with development of outreach materials.

• Address member questions/concerns and identify member needs.

• Understand, explains and adhere to GCHP procedures, protocols, benefits, services and information to members as required.

• Submits member request/inquiries through the established channels in a timely manner.

• Delivers excellent customer service.

• Properly documents all calls/contacts as required by department standards in a timely, clear and concise manner using GCHP's internal tracking system.

• Has a strong command of community resources that address social drivers of health and can make the appropriate referrals to community partners.

• Is trained and can use the Customer Relationship Management (CRM) system to support members with addressing quality care gaps and making an appointment to get their preventative screenings. Along with other necessary internal systems to conduct their job duties.

MINIMUM QUALIFICATIONS

Education & Experience:

• Bachelor's Degree (four-year college or technical school) Preferred Field of Study: Public Relations, Communications, Public Health, Health Care Administration, 2-3 years or related discipline.

• Or any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.

Equivalent In lieu of degree:

• Will accept experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.

• 2-3 years of related experience

Required Qualifications:

Language: Bilingual Required

Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and professional licensure(s)

KNOWLEDGE, SKILLS & ABILITIES

Preferred Qualifications:

Preferred experience in health care interacting directly with members.

Direct experience with Medi-Cal guidelines and health insurance rules and regulations a plus.

Technology & Software Skills: Advanced computer skills in MS Office products.

Competency Statements

• Customer Oriented - Ability to take care of the customers’ needs while following company procedures.

• Accountability - Ability to accept responsibility and account for his/her actions.

• Business Acumen - Ability to grasp and understand business concepts and issues.

• Decision Making - Ability to make critical decisions while following company procedures.

• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.

• Interpersonal - Ability to get along well with a variety of personalities and individuals.

• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

• Consensus Building - Ability to bring about group solidarity to achieve a goal.

• Relationship Building - Ability to effectively build relationships with customers and co-workers.

• Presentation Skills - Ability to effectively present information publicly.

• Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.

• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.

• Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.

• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

• Judgment - The ability to formulate a sound decision using the available information.

• Communication, Oral - Ability to communicate effectively with others using the spoken word.

• Communication, Written - Ability to communicate in writing clearly and concisely.

• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.