Jul 17, 2019
WellCare Health Plans Conducts telephonic outreach to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements. Provides education to members regarding the care gaps they have. Assists in scheduling doctor appointments via three-way phone calls and assists in scheduling transportation services, if needed. Maintains confidentiality of business and protected health information.Department: Health ServicesLocation: Kapolei, HIReports To: Manager Quality Improvement Essential Functions: Conducts telephonic outreach to members to support Quality Improvement, regulatory and contractual requirements. Educates the member and their family about preventive health screenings while identifying barriers to care. Schedules doctor appointments for all household members with care gaps with the Primary Care Physician (PCP) and/or Specialist to access needed preventive care services and close gaps in care via a three-way phone call. Informs providers about the care gap(s) member has and why they are seeing the provider. Arranges transportation for members as needed. Documents all actions taken regarding contact related to member. Interacts with other departments including Customer Service to resolve member issues. Refers to CM/DM as appropriate. Completes special assignments and projects instrumental to the function of the department. Performs other duties as assigned. Education: High School Diploma. Associate's Degree or Bachelor's Degree strongly preferred Experience: 1-2 years' experience in member, provider and customer service or call center environment. Health coaching experience a plus. Some understanding of medical terminology. Experience in managed care helpful. Appreciation of cultural diversity and sensitivity towards targeted populations. Special Skills (e.g. 2nd language): Bilingual skills (English and Spanish) a plus. Excellent communication skills required.Data Entry skillsAbility to communicate effectively and professionally with members and providers. Technical Skills/Requirements: Proficient in Microsoft Office (Word, Excel). About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.
Professional Diversity Network Kapolei, HI, USA Full-Time