Reporting to SNP Care Management Operations Leadership, the SNP Engagement Specialist will be an integral member of the health plan’s medical management team. The SNP Engagement specialist will act in coordination of the SNP Clinical team to provide ongoing coordination of care to members. This position is committed to the constant pursuit of excellence in improving the health status of our members and community. This team member will have high organizational visibility and responsibility in ensuring overall excellence in all areas of care management.
MINIMUM QUALIFICATIONS :
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High School diploma or equivalent.
EXPERIENCE:
1. One (1) year of working in a healthcare or managed care setting.
2. One (1) year of customer service experience.
PREFERRED QUALIFICATIONS :
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Associate Degree in related healthcare field.
EXPERIENCE:
2. Experience with Medicare, Medicaid or SNP populations preferred.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Participate in activities related to care management program build, implementation, oversight, and delegation.
2. Assist in ensuring compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements.
3. Assists in the coordination of transitions of care in coordination with the Care Management clinical staff.
4. Supporting the CM in guiding members through Health Risk Assessment completion and document responses accurately in required systems.
5. Assist the members in coordination of services with guidance provided by the Care Management clinical staff.
6. Conducting timely follow-ups with the members and/or their designated caregivers post transition to ensure planned services have been provided as planned in coordination with the SNP CM and Medicaid coordinators.
7. Educate members on DSNP supplemental benefits (OTC, transportation, dental/vision/hearing, flex cards, etc.) and assist with access.
8. Facilitate scheduling of PCP visits, annual wellness visits, and preventive screenings.
9. Serves as a contact for the D-SNP members to coordinate CM engagement.
10. Assists members in the coordination of services when appropriate and under the guidance of CM.
11. Works closely with the CM and/or SW staff regarding socio-economic issues, such as needed community services or to assist in the establishment of appropriate access to care.
12. Generating and coordinating various members and provider written communications.
13. Documenting in the members’ case accurately and timely to ensure coordination of the members’ care needs.
14. Adhering to all CMS, Code of Federal Regulations, local/state/national regulatory requirements and guidelines as well as those outlined within the MOC.
15. Conduct outbound and inbound calls to DSNP members to welcome them to the plan, explain benefits, and encourage use of covered services.
16. Ensures Accuracy of data entry to prevent downstream errors.
17. Identifies and escalates urgent member needs when identified.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Ability to stand and walk short distances for eight or more hours.
2. Frequent bending, stooping, or stretching.
3. Ability to lift 30 pounds and push 50 pounds.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Standard office environment.
SKILLS AND ABILITIES:
1. Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management and discharge planning.
2. Excellent written and oral communication.
3. Problem solving capabilities to drive improved efficiencies and customer satisfaction.
4. Attention to detail.
5. Proficiency with Microsoft Office products.
6. Ability to work under stressful working conditions.
7. Meeting defined deadlines and deliverables is an imperative skill for this role.
8. Excellent interpersonal, analytical, computer, organizational, verbal and written communication skills essential.
9. Ability to identify problems and opportunities and communicate to management.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Non-Exempt)
Company:
PHH Peak Health Holdings
Cost Center:
2403 PHH Medical Management
