Member Outreach Representative - Health Plan

Location: Baltimore, MD
Date Posted: 02-01-2018
Member Outreach Representative - Managed Care
Baltimore, MD
Your Job Summary:
Member Outreach Representatives are the front-lines of providing excellence in customer care to both internal and external clients.  The position has direct contact with health plan members and some provider facilities and community services throughout the region.  The Representative acts as an advocate for customers (members, providers, facilities, etc.) by providing guidance, interpretation, and education on benefit coverage levels, community social services and agencies, and various program inquires. The Representative works hard to build trusted relationships with members across their health care life cycle.  This includes assisting in, educating members about management of their health and well-being, helping members to maximize health plan benefits and link members to available community resources.  The Representative will primarily interact with members via telephone communication, inbound calls and outbound calls.

Your Reward:  

Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members.  The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance member’s ability to manage their own health.

Your Background:  
Requires an education level of at least a high school diploma or GED.
At least 2-5 years of social services, community outreach, or diabetes education experience. 
Basic familiarity with Medical terminology is required.
Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
Knowledge of health care delivery system, Medicaid/Medicare and related state programs is a significant plus.
Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
Must have a minimum of 40 wpm typing with a high level of accuracy.
Ability to work regularly scheduled shifts within hours of operation.
Bilingual English and Spanish speakers are always a plus!
Your Duties:
  • Assist the health plan in establishing a presence in the community through home visits and community outreach
  • Educate members on health care benefits through home visits and outreach
  • Assist members with activities related to accessing care
  • Document information and activities in applicable systems
  • Deliver cell phones, teach and answer questions related to cell phone use and navigation
  • Coordinate and implement community events, including baby showers and birthday parties, school events, healthy life style events and various community initiatives
  • Schedule and complete home visits for noncompliance, benefits information, ER and readmission diversion and other high risk issues
  • Conduct targeted phone calls for compliance, HEDIS initiatives and health risk assessments
  • Follow-up with appropriate parties on status of high risk member referrals
  • Assist in finding and connecting members to community social services and agencies
  • Ability to travel throughout designated region
Associate Search Consultant
CareNational Healthcare Services
480.448.6498 (CALL – TEXT – FAX)
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