Job type full-time
Full job description
Your future evolves here
Evolent health has a bold mission to change the health of the nation by changing the way health care is deliveredOur pursuit of this mission is the driving power that brings us to work each dayWe believe in embracing new ideas, testing ourselves and failing forwardWe respect and celebrate individual talents and team winsWe have fun while working hard and evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? absolutelyWe have seen about 30% average growth over the last three yearsAre we recognized? definitelyWe were named one of “becker’s 150 great places to work in healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important diversity and inclusion (d&i) efforts: evolent achieved a 95% score on its first-ever submission to the human rights campaign`s corporate equality index; was named on the best companies for women to advance list 2020 by parity.org; and we publish an annual diversity and inclusion annual report to share our progress on how we’re building an equitable workplaceWe recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each dayIf you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a missionJoin 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.
Conduct outbound calls to members (and others on members’ behalf) following scripted protocolsConducts all calls in a courteous and customer friendly manner.
Provide care coordination activities to support specialty populations programs.
Request service plans and research to verify member is receiving appropriate care and servicesFollow up with guardian and/or caregiver as necessary.
Meet productivity and performance expectations as identified by the manager and/or designeeVerify 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 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.eReferral 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 populationsDemonstrate a broad knowledge of 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 effectivelyListen 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 teamMaintain 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
Spanish, mandarin or cantonese fluency required!
Proficient with microsoft outlook, word, excel and powerpoint.
Strong time management and leadership skills
Ability to work independently and solve problems in a fast-paced, quickly changing environment.
Strong organizational and prioritization skills.
Exceptional communication skills, both written and oral
Finishing touches (preferred):
Bachelor’s level social worker preferred
Experience in behavioral health required
1-3 years of health plan experience preferred
During the current pandemic evolent employees are working remotely from homeAs such we require that all employees have the following technical capability at their home: high speed internet over 10 mbps and, specifically for all call center employees, the ability to plug in directly to the home internet routerThese at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.