Retention Specialist

US-NY-New York
1 month ago
Job ID
2017-10726
# Positions
1
ArchCare Catholic Resources, Inc.
Category
Care Management
Work Days Per Week
5
Shift
D
Shift Start Time
9
Shift End Time
5
Type
Full-Time
# Hours
35

Overview

The Retention Specialist reports to the Director of Quality, providing value-added member services support within the Managed Care Population Health Organization. The Retention Specialist contacts members to provide information, education and assistance in utilization of Plan benefits to ensure high post enrollment satisfaction, minimize member disenrollments and identify potential plan upgrades. The specialist will ensure members understand member rights and responsibilities, plan details and benefit eligibility and provide information related to health plan products.

Responsibilities

Essential Functions


 

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Provide Five Star Customer Service to all internal and external customers, including interacting with members and their families to determine member satisfaction.

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Contacts enrolled members to provide information, education and assistance in utilization of ArchCare Community Life Health Plan to ensure high post enrollment satisfaction and minimize member disenrollments.

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Designs, implements and monitors programs to reduce voluntary disenrollments.

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Provides members information on other plan options and identifies plan upgrades based on member eligibility to promote referrals within the integrated ArchCare health system.

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Coordinates member requests to change enrollment status and conducts exit interviews with members choosing to leave the Plan.

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Coordinates internal Member Satisfaction survey, analyzes survey results to identify areas for quality improvement and presents findings to leadership.

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Assists in the coordination of Quality Department meetings and activities including but not limited to the Quality Management Committee and Member Advisory Council and other committees in which QI participates.

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Ensures members understand plan details and benefits, answers inquiries, addresses and resolves complaints/issues.

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Informs new members of anticipated future calls from Assessment and Care Management Teams or other healthcare providers.

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Interacts with Care Management Team to determine member service satisfaction.

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Tracks and documents calls, maintains log of member inquiries, grievance issues and resolutions.

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Updates the Appeals & Grievances electronic health record, database and notifications library, insuring compliance with model notice guidelines and other regulatory requirements.

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Processes Department of Health complaints and consumer advocacy inquiries.

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Acts on behalf of the Plan in New York State Department of Health Fair Hearing proceedings.

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Refers escalated issues to Quality director.

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Ensures compliance with federal, state, and local laws and regulatory standards, DOH and CMS guidelines, and department policies.

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Develops and maintains knowledge of products, services and systems as required.

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Develop, implement and monitor interventions for continuous quality improvement.

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Collect and summarize data for presentation to designated committees and assist in the identification of opportunities for improvement.

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Participates in special projects.

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Performs other QI functions as assigned by the Director of Quality.

Qualifications

Education Desired


 

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Associate’s Degree or equivalent experience

 

Experience Requirements


 

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* Minimum two years of experience in a healthcare setting required * Current knowledge of managed care operations and grievance processing * General knowledge of state and federal regulatory requirements for Medicaid and Medicare in relation to plan operations * General managed care system knowledge – quality, claims, enrollment, provider relations and care management * Strong analytical skills with the ability to collect, organize, analyze, and track and trend information with attention to detail and accuracy.

 

Experience Desired


 

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Previous experience working in a managed care environment.

 

Skill Requirements


 

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* Exceptional problem solving and cognitive skills and an ability to process and report information accurately in a fast paced environment * Excellent interpersonal, oral and written communication and presentation skills, required. * Effective time management and prioritization skills * Excellent writing skills and ability to produce member correspondence in keeping with regulatory requirements * Proficiency with MS Office (MS Word 2013; Excel 97-2003, 2013) *

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