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Personal Care Connector Sr

Company: Amerihealth
Location: Southfield
Posted on: September 9, 2021

Job Description:

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

The Senior Personal Care Connector (PCC) is a high-touch, extremely effective service specialist, responsible for supporting the daily operations of Medicare Member Services (Personal Service Program), integrated care management, and utilization management program interventions.  The Senior VIP PCC must effectively and efficiently perform in a contact center environment, handling escalated calls from Members, Providers and other areas, internal and external to the company. The Sr. PCC oversees projects and leads the day-to-day operations of their team, monitoring workforce management, call adherence, and work scheduling and distribution. The Sr. PCC may also be required on certain days or situation need to handle daily routine calls from Members & Providers in accordance with metric and performance requirements.  Orchestrate, execute, and report on various Call Campaigns, i.e., Care Gaps, HEDIS, PCP Changes, MSP Surveys, Provider/Specialty Termination, OEV, etc.  Primarily responsible to support, train and educate staff, hands on oversight of vendor(s), schedule Integrated Care Team meetings (ICTM), and In-Home Assessments.  Will act as a Subject Matter Expert (SME) on all Plan Related benefits, services and features.   

  • Coordinate transportation with vendors for Members.
  • Act as interface and facilitator between members and provider offices.
  • Effective in/outbound call handling skills to deliver educational messages, collect health data, assess, triage, & offer solutions.
  • Ability to utilize and navigate multiple systems simultaneously.
  • Resolve customer issues via one call resolution guidelines and/or escalated process.
  • Meet or exceed company performance metrics including: availability on phone, occupancy, attendance, call handling quality, call documentation and routing on all calls handled, and adhering to all Regulatory Compliance requirements.
  • Ability to provide solutions to customers while maintaining compliance and service objectives.
  • Responsible for call disposition or compiling and generating reports as required.
  • Assist supervisor with monitoring and coaching on staff attendance, Call adherence and production standards.
  • Will be responsible for minimum side by side and quality call monitoring and entering results into Verient tool.
  • Proven ability to keep accurate and timely records and documentation according to established processes.
  • Will need to attend various leadership and Regulatory meetings and represent our team professionally, demonstrating complete working knowledge of our plan compliance and requirements.
  • Will support supervisor with all reporting requirements associated with the Plan.
  • Is available for employees who experience work problems providing appropriate coaching, counseling, direction and resolution.
  • Works as a member/leader of special or ongoing projects that are important to area/process improvement.
  • Uses appropriate judgment in upward communication regarding department or employee concerns.
  • Coach and serve as a resource to others in the Call Center.
  • Coordinate and manage the distribution of workflow for designated customer service team in the Call Center.

Education/ Experience:

  • High School/GED.
  • Associate’s Degree preferred.
  • Must have detailed operational knowledge of Medicare Facets, JIVA, CHAMPS/Care Connect 360, and/or SC Medicaid/Phoenix, and/or PA State System – All three State systems preferred.
  • Effective telephone skills to handle in-bound calls for triage and resolution.
  • Professionally handle incoming inquiries from customers regarding benefit eligibility or customer issues.
  • Ability to handle multiple tasks simultaneously.
  • 3 to 5 years minimum working knowledge of Medicare & Medicaid.

Other Skills:

  • Proficient PC skills with Microsoft Suite (Word, Excel, etc.).
  • Effective oral and written communication skills.

      

Keywords: Amerihealth, Southfield , Personal Care Connector Sr, Other , Southfield, Michigan

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