Member Care Coordinator 27091

Solving IT

Job Description

One of the largest health insurers in the nation is focused on continuously building an industry-defining, world-class IT capability. Healthcare is forever evolving, especially due to emerging technologies, making this a great experience to add to your resume. Come join their winning team!

This contract to hire role as a Member Care Coordinator in Downers Grove, IL is responsible for conducting home health assessment, contacting identified members to inform and educate them on health care programs to address their personal health plan needs, engaging the member in discussion of adherence to personal health plans, responding to inquiries from members, and supporting the clinicians in the Medical Management department with their provider and member activities. This role is remote until a return to work is established.

Responsibilities:

 


•        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. Respond to customer or send to appropriate internal party.


•        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.

Requirements:



•        Bachelor of Social Work or Psychology OR LVN, LPN with 1 year experience in managed care systems OR RN OR 3 years care coordination for a state managed or waiver program OR 3 years managed care systems experience.


•        Knowledge of medical terminology


•        Experience coordinating member medical related needs, providing assistance to members, and analyzing member needs


•        PC proficiency including Microsoft Office applications


•        Customer service skills


•        Verbal and written communications skills including developing written correspondence to members and to other department personnel and coaching skills, including motivational interviewing, to educate members on medical issues


•        Current state driver license, transportation, and applicable insurance


•        Ability and willingness to travel


Benefits: 


Solving IT is pleased to offer a rich benefit plan to our W2 employees. We offer five health plan options and a PPO dental plan through Blue Cross Blue Shield, Term Life/AD&D Insurance, and 401(k) Savings Plan. Solving IT subsidizes the health and dental premium for the employee.


As you continue to develop your skills and experience, Solving IT will work with your changing preferences to match you with rewarding projects. Our unrivaled reputation for quality is demonstrated through our Inavero Best of Staffing award that was won due to the feedback from our own clients and candidates. We also love to socialize and have fun so we have regularly scheduled parties and events for you to unwind and network with fellow consultants. 


Whether you are searching for your next challenge or just looking to stay on top of market trends, Solving IT is committed to help position you appropriately. By leveraging the latest market and compensation data available, you can rest assured that you are getting more than just an informed opinion. You are getting the Solving IT Experience.

Job Requirements

 

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