OneCare Partner- Services
CalOptima - Orange, CA

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This position will provide telephonic and in person customer service to OneCare members, facilitating the direction of each inquiry regarding access to healthcare, community, and other services. OneCare Customer Service Partners monitor follow-through on needed care and follow-up on open issues. They work closely with clinical staff to assist members in resolving healthcare and psychosocial related issues. In addition they maintain an outreach effort which includes calls welcoming members into the program, 45-day follow-up calls, and birthday greeting calls, to nurture open communication and understanding of the program. OneCare Partners may also perform outreach activities at cultural events/fairs within Orange County, on occasion, in conjunction with the Community Relations department. The ideal candidate will be very customer service oriented and possess the ability to conduct new member orientation meetings. Candidates must be bilingual in English/Spanish or English/Vietnamese.

Position Responsibilities
  • Assist with coordination of member’s health care and social service needs both within and outside the Medical Group and CalOptima. Maintain documentation of member cases within the FACETS system.
  • Initiate referrals to both internal and external care management departments and other department/government or community agencies.
  • Participate in special events/fairs outside of regularly scheduled working hours, as needed only.
  • Participate in departmental phone outreach campaigns on a regular basis.
  • Other projects and duties as assigned.
Required Skills
  • Develop rapport, establish and maintain effective interpersonal relationships with internal and external contacts at all levels.
  • Maintain accurate records and documentation.
  • Prepare and provide effective orientations and education presentations.
  • Work with Case Management staff to expedite the resolution of member concerns.
  • Remain knowledgeable of the medical groups and OneCare’s benefit structure.
  • Communicate effectively, both verbally and in writing with individuals from varying cultural and ethnic backgrounds.
  • Speak, understand, read and/or write a second language in addition to English may be required for some assignments.
Required Experience

Experience & Education
  • 2+ years experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity.
  • HMO, MediCal/Medicaid and health services experience preferred.
  • Bachelor’s degree recommended.
  • CA Driver’s License and reliable transportation is required for some assignments.
  • Bilingual in English/Spanish or English/Vietnamese required.
Knowledge of:
  • Medicare and Medi-Cal eligibility and benefits preferred.
  • Issues that face members with special needs, such as seniors and persons with disabilities.
  • Principles and practices of health care service delivery and managed care, Medi-Cal/ CalOptima eligibility and benefits.
  • Principles and techniques to serve the SPD population in diverse social and ethnic groups.
  • Personal computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.

CalOptima - 16 months ago - save job - block
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