Position Purpose:
Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities.
Education/Experience:
Requires a High School diploma or GED
Requires 1 – 2 years of related experience
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Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed
Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan
Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service
May support performing service assessments/screenings for members and documenting the member’s care needs
Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed
Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards
Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager
Provide education on benefits and resources available
Performs other duties as assigned.
Complies with all policies and standards.
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 CM MMA Support Team connects members to the right services through outreach, referral support, resource navigation, and care coordination activities that improve member outcomes and experience
Critical backfill
The team is collaborative, fast-paced, and member-focused. Key projects include member outreach, assessments, Care Management referrals, resource navigation, quality improvement activities, and referral queue support
No additional hiring needs are identified currently. This request is intended to support current business and operational needs.
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?
The role includes member outreach, completing assessments, identifying Care Management needs, documenting activities in TruCare, managing referrals, supporting resource navigation, and collaborating with internal teams to address member needs
Performance is measured through productivity, outreach completion, documentation accuracy, quality standards, timely referral processing, and achievement of department goals.
This role supports multiple programs and populations, providing a diverse mix of outreach, care coordination support, referral management, and resource navigation that directly impacts member health outcomes.
Candidate Requirements
Education/Certification
Required: High School Diploma
Preferred:
Licensure
Required: N/A
Preferred:
Years of experience required: Requires 1 – 2 years of related experience
Disqualifiers:
Additional qualities to look for:
- Top 3 must-have hard skills stack-ranked by importance
1
Detailed oriented
2
Be able to multitask
3
Fast learner
4
Have experience in this background to understand tasks at hand
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, phone, etc.
Required Testing or Assessment (by Vendor):
Typing test, basic computers skills test, etc.
License/Certification:
For Florida-Sunshine Health Plan - All interactions with members are done telephonically.
For Arkansas Total Care plan - This position is designated as safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment check (before hire and recurring), and a drug screen (at time of hire and recurring). Must reside in AR or border city. Travel: 30%. required" "Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate
Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed
Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan
Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service
May support performing service assessments/screenings for members and documenting the member’s care needs
Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed
Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards
Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager
Provide education on benefits and resources available
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.”
