BusinessOperations - Care Management Support Coordinator II - J01003

Performs administrative care management support activities such tracking compliance, verifying eligibility, and collaboration with state stakeholders and staff to resolve issues in accordance with current state and regulatory guidelines. Candidate Requirements Education/Certification Required: High School Diploma Preferred: Thorough knowledge of customer service, utilization of review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer.

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

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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Performs administrative care management support activities such tracking compliance, verifying eligibility, and collaboration with state stakeholders and staff to resolve issues in accordance with current state and regulatory guidelines. Track Compliance ( Use and read reports to track and monitor members requesting services.) Monitor the Postings email box daily for urgent state complaints inquiries. Uploading and download spreadsheets from sftp portal. Navigate through multiple systems. (adaptability) Perform daily quality checks. Case studies/audits to escalate accordingly. Outreach to Internal and external stakeholders Data Entry Verify member eligibility. All employees go through corporate Onboarding training Tracking Team Training Peer-to-Peer
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?		Collaboration with Service Coordination and State Support Unit Compliance tracking and MCO to MCO transfers Staffing changes Quickly fill the position to aid in the day to day and backlog
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?		M-F 8:00 am 5: ppm CST No OT on a regular basis: mandatory OT may be required occasionally Compliance Tracking
Candidate Requirements
Education/Certification	Required: High School Diploma			Preferred: Thorough knowledge of customer service, utilization of review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Knowledge of medical terminology.
Licensure	Required: None			Preferred:
Years of experience required: Disqualifiers: Additional qualities to look for: Proficient Typing Computer Skills Attendance/Reliability needed Excel experience (Read and Understand data and reporting), Ability to Multitask Proficient Typing Critical Thinking Ability to communicate effectively Data Entry Self-Motivated Adaptability Attention to detail PowerPoint MCO Experience
Top 3 must-have hard skills stack-ranked by importance		1	Excel and computing skills
		2
		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:			Teams with camera
		Required Testing or Assessment (by Vendor):
Next Steps
Do you have any upcoming PTO?
Colleagues to cc/delegate		Marivel Randall and Cristal Saenz