Position Purpose:
Supports administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines.
Education/Experience:
Requires a High School diploma or GED
Requires 1 – 2 years of related experience
License/Certification:
For Florida-Sunshine Health Plan - All interactions with members are done telephonically
Provides outreach to members via phone to support with care plan next steps, community or health plan resources, questions or concerns related to scheduling and ongoing education for both the member and provider throughout care/service
Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service
May apply working knowledge of assigned health plan(s) activities and resources
Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures, and protocols
Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship
Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed
Knowledge of existing benefits and resources locally and make referrals to address Social Determinants of Health (SDOH) needs
Performs other duties as assigned
Complies with all policies and standards
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
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Story Behind the Need - What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
The Team member work on obtaining Physician Signature Of Need and Medical Necessity forms that are signed by the PCP.
2. Backfill for FTEs
3. We work remote but have interaction with each other through IM and virtual team meetings.
4. No
Typical Day in the Role - Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
- Team member will be making outbound calls to members and Providers. They are to make their notes in TruCare Cloud. They will be logging Incomplete forms that they receive from PCP on our SharePoint site. Also, they will be correcting an errors that they make on their notes.
- They are to make 25 notes per day per our metrics.
- They will be communicating with members and providers on a daily basis.
- Case load 25-35 members per day
- MUST HAVE A CELL PHONE FOR VPN LOGIN
Applications Centene – Trucare, Sharepoint, Amysis, impact pro, cloud,
Applications other – Teams, Outlook, excel, one note (daily), faxcom
Candidate Requirements Education/Certification Required: HS Diploma or GED Preferred:
Licensure Required: None Preferred: Years of experience required: 2 years of Medical Experience.
Call center, PCP office experience and/or managed care experience.
MUST HAVE A CELL PHONE FOR VPN LOGIN
Disqualifiers: Overqualified for this position, MUST be able to work independently and ability to troubleshoot, Per HIPPA must have a professional & private area to work, job hopping (please state if contract and if completed), position longevity (manager wants someone that is serious about the role and wanting to grow with Centene)
Additional qualities to look for: Multi-tasking, computer literate
- Top 3 must-have hard skills stack-ranked by importance
1 Must be able to work remote/independently/troubleshooting skills 2 Computer literate-type at least 50 words per minute 3 Knowledge of Excel, Outlook and Teams, One note, computer savvy in general
Candidate Review & Selection - Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
Projected Manager Candidate Review Date:
1-2 days post shortlisting Type of Interviews:
Teams CAMERA ON Required Testing or Assessment (by Vendor):
TYPING TEST 50 WPM, 95% accuracy Attach with the resume please Next Steps - Do you have any upcoming PTO?
No
- Colleagues to cc/delegate
Graciela Avila-Solis 
