About this role
Coordinates and facilitates the delivery of multiple services offered to Health Plan members across various products. Collaborates with clinical care teams, providers and vendors to promote optimal service. Collects and analyzes service metrics to facilitate continual process improvement.
1. Collaborates with clinical care management team to ensure product members receive services based on treatment plan.
2. Secures member services utilizing network providers and contracted vendors within member’s health plan (i.e. physician office visits, inpatient/outpatient services, homecare, transportation, etc.).
3. Establishes, builds and maintains relationships with service providers, referring offices, product members, representatives, etc.
4. Educates and guides members in navigating services offered. Provides follow-up and coordination to ensure services are provided.
5. Collaborates with referring departments, physician offices, etc. to ensure patients are directed to appropriate resources.
6. Provides guidance, research and issue resolution related to service coordination to members, providers, and clinical care team.
7. Enters and maintains concise service-related information in Health Plan database.
8. Maintains consistency and integrity of data collection. Performs regular database maintenance to ensure information accuracy.
9. Analyzes and trends service activity data. Identifies unusual events or consistent problem areas. Prepares metrics and reports for management review.
10. Recommends and implements methods to update, simplify and enhance processes, procedures and technologies.
11. Performs related duties, as required.
*ADA Essential Functions
• Associates Degree in related field, required. Bachelor’s Degree, preferred.
• Minimum of two (2) years progressively responsible healthcare administration experience, required.
• Demonstrated knowledge of health insurance plan administration, including Medicare and Medicaid, required.
• Proficiency in Microsoft Office applications, required.
• Excellent interpersonal, oral and written communications skills and problem resolution skills, required. Bilingual skills, preferred.
All your information will be kept confidential according to EEO guidelines.