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Enhanced Care Management Outreach Specialist I

3 months ago

Bakersfield, United States KHS Full time

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

KHS reasonably expects to pay starting compensation for the position of Enhanced Care Management Outreach Specialist I in the range of $19.56 - $25.64 hourly.

Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

JOB SUMMARY:

This position reports to the Enhanced Care Management (ECM) Supervisor this position provides support to the ECM Program to ensure engagement, enrollment and follow up on members related to the ECM as well as other clinical programs in which outreach and engagement are central. This position will also play a central role in partnering with the ECM sites and KHS ECM Care Team.

Essential Duties and Responsibilities:

  • Has an understanding of theories of change, motivational interviewing, and patient centered medical home
  • Knowledge of the healthcare industry and familiarity with managed care plan designs and benefits
  • Possesses excellent written and verbal communication with contract providers and internal KHS staff to promote effective and timely coordination of care and dissemination of KHS policies and procedures.
  • Professional communication and ability to collect and share data with providers
  • Provide member resources such as customer service related to the ECM
  • Outreach to members and tailor the conversation according to their readiness to enroll in ECM
  • Coordinate ECM disenrollment
  • Address member concerns with specialist referrals and appointments, transportation to medical services etc
  • Responsible for making failed appointment calls in an effort to reschedule member
  • Resolve ECM member concerns identified through Member Services
  • Coordinate internal and external referrals for ECM enrollment
  • Make outbound calls using effective outreach techniques to promote member engagement to enroll in ECM
  • Answer inbound calls to determine member needs and promote member engagement into the ECM
  • Conduct outreach aimed at enrolling individuals who are eligible for the ECM program. Outreach will be telephonic or in person at the members home or provider's office. Often, multiple attempts at multiple types of outreach will be required.
  • Manage and process member incentives according to the approved member incentive program
  • Research other phone numbers and contact information if documented information is inaccurate
  • Perform outreach at member's home or other location to promote optimal member engagement
  • Use problem-solving and critical thinking skills to respond to member's concerns. Have a thorough knowledge of KHS departmental resources and ability to coordinate members care with different departments.
  • Assists management staff in completing member services related special projects.
  • Organizes and maintains departmental files, records
  • Utilizes computer for detailed data entry in multiple applications including Microsoft Office, Jiva
  • Engages in activities related to other clinical services initiatives
  • A willingness to work effectively in a team
  • Understands the Outreach process by ECM Provider to ensure successful member engagement.
  • Assist member with any inquiries regarding ECM services.
  • Assist ECM enrolled member with ECM Provider transfers as needed.
  • Assist with member grievances as needed.
  • Assist members with transportation requests.
  • Complete Qnxt assigned call tracking on a daily basis.
  • Complete Jiva cross functional internal Health Services referrals.
  • Coordinate ECM disenrollment
  • Provide staff coverage as needed
  • Regular Predictable attendance
Employment Standards:

Education: High School Diploma from an accredited school or equivalent required. Associates degree or Medical Assistant (MA) Certificate preferred. Additional years of experience within a medical environment preferred.

Experience: Three (3) or more years of recent experience in customer service-related field with a high degree of problem solving and decision making. Strong telephone and communication skills required. Preferred experience in a patient centered medical home.

Certifications:BLS/CPR certification within 3 months of hire or internal transfer.

Home Visit Health Requirements:
  • TB Test
  • Influenza (Vaccination) or Declination
Other:Possession of valid driver's license and proof of State required auto liability insurance. Required Travel Up to 20%

Knowledge of: Excellent customer service and telephone techniques and etiquette. Health Maintenance Organizations (HMO) desirable.

Ability to: Work under pressure; work independently and manage multi-task responsibilities; be willing and able to assist and educate the member; intervene effectively in crisis situation on behalf of an upset, distraught, dissatisfied, confused or angry member; solve complex and comprehensive problems; organize and set priorities; adhere to state and federal timelines; have excellent communication skills both written and verbal and work in a rapidly evolving work environment.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

Other details
  • Pay Type Hourly
  • Min Hiring Rate $19.56
  • Max Hiring Rate $25.64
  • Travel Required Yes
  • Travel % 20
  • Telecommute % 0
  • Required Education High School


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