Serves as the liaison and advocate for members in support of the Synergy Personal Health Management Program. Provides education, assessment and outreach to high risk and/or non-compliant members with chronic diseases to encourage participation in the Synergy program. Serves as the direct interface with network practitioners, providing outreach, education, and clinical guidance on program strategies. Works closely with Client clinical departments to ensure collaboration between the Health Plan and the Synergy program staff. This position may not conduct any activities that require evaluation or interpretation of clinical information .
CORE COMPETENCIES: High-Impact Communication, Formal Presentation, building Strategic Work Relationships, Building Trusting Relationships, sustaining Customer Satisfaction
Education/License/Certification: Bachelor’s Degree in a health related field. Master’s Degree preferred, such as MSW, MPH, MHA, MSN, etc. Licensure as a health professional desirable.
Experience: Minimum of three years experience in a health care delivery environment, managed care plan, or Disease Management provider. Experience as a consumer or family advocate, either in volunteer or paid settings, with
knowledge of Medicaid and Medicare regulations/standards preferred.
- Knowledge of Medicaid and/or Medicare health care delivery system
- Knowledge of local and community resources and social services
- Knowledge of disease management processes
- Case Management Skills
- Independent, highly organized team player
- Able to handle multiple tasks simultaneously
- Must be able to access, research and extract information from printed and online resources
- Knowledgeable in case management software systems
- Excellent verbal and written communication and presentation skills
Health Integrated is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, sexual orientation, political affiliation, color, religion, national origin, age, disability, veteran status, genetic data, or religion or other legally protected status. EOE M/F/D/V
- Assists call center Care Coach Staff in locating and/or engaging high risk and/or non-compliant members with chronic diseases. .
- Builds and maintains library of community and social service resources to support Care Coach Interventions.
- Works closely with customers to assist in training on the Synergy program, consumer rights and responsibilities, self-help, recovery, and advocacy.
- Acts as a liaison between the customer’s UM/CM department(s) and the Synergy program.
- Maintains a strong working knowledge of local practitioner networks as well as local and state resources for health care treatment.
- Facilitates problem resolution related to specific patient issues, working effectively with Care Coaches, providers and provider office staff.
- Facilitates coordination and collaboration with network practitioners through ongoing communication and outreach activities.
- Maintains open communications with customers in the coordination of provider activities as necessary and appropriate.
- Conducts ongoing education and re-orientation for providers and their staff on Synergy program strategies.
- Attends all consumer and key advocacy meetings and maintains memberships within these organizations.
- Conducts educational and outreach training activities for members with chronic diseases in conjunction with customer health fair and training programs.
- Conducts formal investigations on consumer complaints and ensures the issues are followed through to resolution.
Health Integrated - 11 months ago