Job Details

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 outreachto 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."

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
Story Behind the Need

• What is the purpose of this team?
• 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 Specialty Authorization Team consists of the processing of authorizations and follow-ups for DME, MHM, DAHS, and reductions/denials in which we are now at a 1 Client TAT for the processing of SK/SH/MMP authorizations. We utilize project temps/contingent workers to assist with each of these areas as well as cross train them to be able to assist in multiple functions. The team continues to experience high authorization volumes. We work together like a family rather than co-workers in which helps facilitate the best care for those we serve by being committed, flexible, and compassionate to enhance the lives of each and every Member. 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?

• Daily check in & communication via group IM(s)
• Daily production logs must be completed and emailed to designated individual no later than 9am next business day
• Multi-tasking with multiple monitors and applications
• Utilize work guides and or resources
• 97% Quality (Audits)
• 98% Production

0-5% Error Rate Candidate Requirements Education/Certification Required: High School/GED Preferred: LPN, LVN, or LCSW preferred. Licensure Required: Preferred: Years of experience required: 2+ years of experience in a managed care environment or working with people who have disabilities and/or with vulnerable populations who have chronic or complex conditions. Other state specific requirements may apply.

Disqualifiers:

dditional qualities to look for: Other state specific requirements may apply.
Preferred : LPN, LVN, or LCSW preferred

• Top 3 must-have hard skills stack-ranked by importance

1 Microsoft Outlook, Microsoft Teams, Zoom, Microsoft Word, Microsoft Excel, SharePoint, Internet 2 2+ years of experience in a managed care environment or working with people who have disabilities and/or with vulnerable populations who have chronic or complex conditions. 3 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:
phone Required Testing or Assessment (by Vendor): Computer Literacy test