Role Description
In this role, you will assist in resolving patient/member concerns, providing appropriate education/instruction and maintaining patient/member satisfaction by providing the highest level of clinical support. Assists and educates patients/members about available services through motivational interviewing, problem solving, interpreting complex clinical problems, researching information, contacting providers and providing patient/member information. Assists patient/members with social determinants of health, special needs, and/or crisis situations by helping to identify the problem(s) through interviewing skills, identifying primary and secondary resources, by discussing options with the patient/member, and helping them decide on the plan of action. Advocates for patient/member who are incapacitated by age, physical or mental illness or handicap, or who are otherwise unable to communicate with various service delivery systems effectively.
Job Duties
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Serves as the primary contact for Enhanced Member Supports Unit, Behavioral Health and network for patients/members/providers.
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Assesses all clinical issues and concerns to assure accurate information is provided promptly to patient/member/provider.
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Manages crisis situations with patients/members and triages appropriately.
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Provides assistance with concerns related to social determinants of health.
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Completes resolution for all patient/member/provider concerns and inquiries.
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Provides daily support and direction to patient/member/provider services staff.
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Obtains data on callersβ needs for use in monthly statistical and activity reports.
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Communicates and coordinates with the appropriate internal department to resolve issues.
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Collects and records data on special needs organizations, facilities and services.
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Prepares, generates and appropriately disseminates letter communications to patients and members.
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Provides training within the team as needed.
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Explores covered benefits and community resources as applicable by line of business and product design.
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Provides team building resources to help direct peers to appropriate policies and procedures to assist patients/members/providers.
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Completes outbound calls to patients/members/providers to resolve complex eligibility issues.
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Navigates multiple computer programs while assisting patient/member/provider.
Position Details
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Hours: 8:30am-5pm
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As this role is listed as Work From Home - we are only accepting applications for those that live in PA.
Qualifications
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Bachelor's Degree in a related field of study (Social Work, Healthcare Administration, Psychology, Public Health, Human Services, or a related healthcare/behavioral health field)
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Minimum of 1 year of related work experience
Requirements
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Bachelor's Degree-Related Field of Study (Required)
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Minimum of 1 year-Related work experience (Required)
Benefits
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Full benefits (health, dental and vision) starting on day one
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Three medical plan choices, including an expanded network for out-of-area employees and dependents
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Pre-tax savings plans with healthcare and dependent care flexible spending accounts (FSA) and a health savings account (HSA) with employer contribution
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Company-paid life insurance, short-term disability, and long-term disability coverage
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401(k) plan that includes automatic Geisinger contributions
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Generous paid time off (PTO) plan that allows you to accrue time quickly
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Up to $5,000 in tuition reimbursement per calendar year
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MyHealth Rewards wellness program to improve your health while earning a financial incentive
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Family-friendly support including adoption and fertility assistance, parental leave pay, military leave pay and a free Care.com membership with discounted backup care for your loved ones
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Employee Assistance Program (EAP): Referrals for childcare, eldercare, & pet care; Access free legal guidance, mental health visits, work-life support, digital self-help tools and more
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Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life and pet and legal insurance