BusinessOperations - Care Engagement Specialist 1 - 210938

Education/Experience: High School diploma or equivalent and 3+ years of sales experience in a call center or other high pressure sales environment, or experience in member, provider, customer service, or call center; or Bachelor degree in healthcare, business administration, or related field and 1+ years of sales experience in a call center or other high pressure sales situation, or experience in member, provider, customer service, or call center. Candidate Requirements Education/Certification Required: High school Preferred: CHW Licensure Required: Preferred: Years of experience required: 2+ years work experience- outbound experience, some office experience, working from home experience.

Position Purpose: Care Engagement is responsible for supporting the organization s goals of obtaining health needs screenings, scheduling preventive service appointments and educating members on plan benefits and services. Provide members with educational materials and carry out strategies to increase health care adherence and reduce barriers to care.

Education/Experience: High School diploma or equivalent and 3+ years of sales experience in a call center or other high pressure sales environment, or experience in member, provider, customer service, or call center; or Bachelor degree in healthcare, business administration, or related field and 1+ years of sales experience in a call center or other high pressure sales situation, or experience in member, provider, customer service, or call center. Bilingual in Spanish and English preferred.

Make outbound or receive inbound calls from members to schedule doctor appointments, assist members that need to complete Health Needs Screenings or make payments to become eligible for enhanced benefits.
Influence members to take advantage of additional benefits available by educating members on enhanced services that are available and recommending preferred providers.
Educate members on utilization of Emergency Departments in non-emergent conditions and the impact to their benefits.
Identify and overcome barriers in order for members to complete needed health screenings, obtain needed services or make payments to secure enhanced benefits.
Review each member profile prior to outreach to identify areas of opportunity, which includes but is not limited to reviewing additional benefits available for members and identify opportunities for members to become eligible for additional benefits.
Participate in continuous quality improvement initiatives to ensure department and company goals are met and exceeded.
Review and analyze data for call reports to make adjustments as needed to call approach for members in order to obtain information.
Act as a secondary resource for the Member Services or Provider Services call centers.

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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Position Purpose: Care Engagement is responsible for supporting the organization s goals of obtaining health needs screenings, scheduling preventive service appointments and educating members on plan benefits and services. Provide members with educational materials and carry out strategies to increase health care adherence and reduce barriers to care. Education/Experience: High School diploma or equivalent and 3+ years of sales experience in a call center or other high pressure sales environment, or experience in member, provider, customer service, or call center; or Bachelor degree in healthcare, business administration, or related field and 1+ years of sales experience in a call center or other high pressure sales situation, or experience in member, provider, customer service, or call center. Bilingual in Spanish and English preferred. Make outbound or receive inbound calls from members to schedule doctor appointments, assist members that need to complete Health Needs Screenings or make payments to become eligible for enhanced benefits. Influence members to take advantage of additional benefits available by educating members on enhanced services that are available and recommending preferred providers. Educate members on utilization of Emergency Departments in non-emergent conditions and the impact to their benefits. Identify and overcome barriers in order for members to complete needed health screenings, obtain needed services or make payments to secure enhanced benefits. Review each member profile prior to outreach to identify areas of opportunity, which includes but is not limited to reviewing additional benefits available for members and identify opportunities for members to become eligible for additional benefits. Participate in continuous quality improvement initiatives to ensure department and company goals are met and exceeded. Review and analyze data for call reports to make adjustments as needed to call approach for members in order to obtain information. Act as a secondary resource for the Member Services or Provider Services call centers.
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?		This team supports member outreach, care coordination, and preventive health efforts for WellCare of Kentucky. These openings are driven by business need and increased workload to support outreach goals and member engagement. The team is collaborative, fast-paced, and focused on helping members access needed care and services. Key projects include Medicare HEDIS measures. This request is not currently tied to a larger hiring initiative, though future needs may come up based on business demand.
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?			This role focuses on outbound member outreach, care coordination support, and helping close preventive care gaps such as APV appts, CBP,BCS, A1C testing, mammograms and colonoscopies. Day to day, team members make and receive calls, educate members, help schedule appointments, document outreach, and coordinate follow-up activities. Performance is typically measured through productivity, quality of documentation, member engagement, and success in supporting outreach goals. What makes this role unique is the direct impact on member health outcomes, the variety of outreach campaigns supported, and the opportunity to work in a fast-paced, mission-driven environment serving Kentucky members.
Candidate Requirements
Education/Certification	Required: High school				Preferred: CHW
Licensure	Required:				Preferred:
Years of experience required: 2+ years work experience- outbound experience, some office experience, working from home experience Disqualifiers: employment gaps, not able to hold conversations with patients- do not want someone who reads off a script Additional qualities to look for: need to be able to work with multiple screens, multi-tasking, able to document while maintaining a conversation
Top 3 must-have hard skills stack-ranked by importance			1	Outbound call handling and member outreach experience
			2	Accurate documentation and data entry in multiple systems
			3	Appointment scheduling and care coordination support for SDOH resource needs
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, It is an expectation that the interview will be on camera with stable internet.
			Required Testing or Assessment (by Vendor):			Computer skills test
Next Steps
Do you have any upcoming PTO?			Our calendars are up to date
Colleagues to cc/delegate			Tracy Steinberg, Jessica Young- doing interviews
Compliance Questions