It’s Time For A Change…
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—70.3% in year-over-year revenue growth in 2017. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
What You’ll Be Doing:
This position is responsible for conducting member outreach to complete basic health surveys, to identify member needs for care coordination activities, to implement selected interventions according to program guidelines for members, to track and document member's status and progress, and to refer to clinical staff as appropriate.
- Provide Care Coordination activities to support Specialty Populations programs.
- Request service plans and research to verify member is receiving appropriate care and services. Follow up with guardian and/or caregiver as necessary.
- Conduct outbound calls to members (and others on members’ behalf) following scripted protocols. Conducts all calls in a courteous and customer friendly manner.
- Meet productivity and performance expectations as identified by the Manager and/or designee. Verify member eligibility according to the appropriate eligibility system.
- Collect demographic and survey data according to script, tools, and protocols.
- Communicate directly with members to identify any care coordination needs and to provide information regarding health care access and preventive health interventions/screening.
- Complete member specific interventions according to program guidelines and member-specific care plans developed by Care Advisors or Health Educators.
- Increase member's adherence to program guidelines by coordinating with primary care physicians.
- Interact with providers and other Plan staff as needed to meet member objectives and improve health outcomes
- Document all member-related efforts in the appropriate medical management system.
- Assist members with needs such as: obtaining physician appointments, resolving transportation issues, obtaining appointments for preventive health screenings, and telephonic appointment reminders.
- Educate members regarding community resources and access to care.
- Serve as a contact for DCBS, DAIL, Foster Parents, Adoptive Parents, and other entities serving assigned populations.
- Maintain and submit reports detailing the number of service plan reviews completed, including key data points and outcome decisions (i.e. referral to Case Management and rationale for decision).
- Maintain a report of issues encountered by members in assigned populations; suggest solutions to recurring problems, work with other teams as needed.
- Conduct and document the care coordination processes, focusing on the whole health needs of all assigned members, and including assisting in resolving issues encountered by members related to accessing needed care and treatment.
- Act as a liaison between member, provider and health plan to assure healthcare services are provided in the most appropriate and cost-effective manner.
- Facilitate access to entitlement programs and/or community resources.
- Follow up regularly with members, guardians, and/or caregivers to ensure members’ care needs continue to be met appropriately.
- When assigned by Manager, participate in meetings with external entities such as state and/or community partners, caregivers, or members.
- Complete referrals to Care Management
- Identify members’ immediate and future Care Management, Behavioral Health, and special needs according to program guidelines.
- Document agreement to participate in Care Management program according to prepared script and/or protocols.
- Complete referral for Care Management program when indicated based on established guidelines.
- Identify and correct problems with special populations. Demonstrate a broad knowledge of PHP, Medicaid benefits, services, and requirements.
- Perform administrative duties tied to care coordination activities
- Processing/scan documents, mail requests, fax documents, and document retrieval.
- Assist with the generation and processing of member correspondence and educational material.
- Document information required for outcome measurements.
- Attend required annual trainings.
- Complete/maintain reports as requested by Manager.
- Comply with HIPAA confidentiality standards to protect the confidentiality of member information.
- Live the Values
- Communicate effectively. Listen attentively to others.
- Seek creative solutions that meet the needs for all parties involved.
- Cooperate with others to achieve departmental goals, interdepartmental relations, and public relations.
- Adapt to change in a way that promotes success with minimal disruption of departmental activities.
- Display willingness to work as part of a team. Maintain cooperative relationships with all team members.
- Demonstrate knowledge of NCQA, HEDIS, and program goals.
- Perform other duties and projects as assigned.
The Experience You’ll Need (Required):
- Associates degree in a related field; or equivalent combination of education and experience preferred
- Proficient with Microsoft Outlook, Word, Excel and PowerPoint.
- Strong time management and leadership skills
Finishing Touches (Preferred):
- Bachelors degree in a related field
- 1-3 years of health plan experience
Licenses, Registrations or Certifications:
- Certification as a medical assistant, home health aide, nursing assistant, or other similar health care para-professional preferred (If candidate holds a degree in social work, a license or certification is required.)
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.