Professional, Care Guide

MVP Health Care•Schenectady, NY

3d•Hybrid

About The Position

As a Care Guide at MVP Health Care, you will play a crucial role in enhancing our members' healthcare experience. This role supports a customer’s care journey during their time with MVP through high quality interactions and experiences. The Care Guide works directly with customers and, as appropriate, customers’ family and/or advocates to ensure that they have a smooth transition to their plan and fully understand their benefits and resources available to them as they use their plan. The Care Guide collaborates with Plan Guides during the sales processes to provide deep benefit and product knowledge that guides a prospective customer to their best plan options and serves as the escalation and transition point for customers with clinical needs to Care Management. This includes connection to resources that support, promote, and facilitate engagement in MVP programs that support the customer’s health and wellbeing. The Care Guide will support the customer’s care journey regardless of the intersection points with the plan, collaborating with a broader multi-disciplinary clinical care team, and/or other internal departments as appropriate to support the customer’s ongoing needs in addition to onboarding. They will act as a liaison to support engagement with the plan, and coordination with Provider Partners in each of MVP’s regions by assisting members in reducing/resolving challenges or barriers so that the member may achieve their optimal level of health, independence, safety, and well-being. The Care Guide identifies opportunities to develop relationships with customers that are meaningful to customers and expand their knowledge of MVP products and their support of member well-being. Ultimately, the Care Guide serves as the bridge between the customer, the health plan, and the customer’s provider to create a seamless and positive experience to fulfill their unmet care needs. The Care Guide further coordinates and manages the resolution of highly complex and specialized, non-routine customer issues and supports Plan Guides and other Customer Care staff with expedited and non-routine customer issues. The Care Guide demonstrates MVP core values in all interactions with customers, customer advocates, and providers. The Care Guide will build individual capacity by increasing health and wellness self-management skills and sufficiency through a series of activities such as outreach, education, informal counseling, social supports, and advocacy. The position will empower customers to make informed decisions and advocate on their behalf when deemed necessary and be a resource for a future time in which the customer may have additional questions about their care, benefits, or coordination within the health system.

Requirements

Minimum of 3 years successful experience working within a managed care or health services environment.
Experience in customer service and understanding and responding to customer needs.
Experience in positions where adherence to strict confidentiality and experience implementing process improvements is required.
Ability to empathize and 'be in the shoes' of MVP members, understand how issues impact them, and act as a member advocate.
Willingness to meet directly with members, their families, advocates, in office, home settings or other as warranted by customers.
Commitment to high ethical standards in all work. Protects the privacy of member and MVP data and exercises discretion in handling confidential member information.
Deep knowledge of Medicare, Medicaid, Commercial programs and products and understanding of current health care market and products/resources available in the community, social services, and public resources.
Ability to collaboratively work with team to assist and resolve customer concerns and complaints.
Strong communication and interpersonal skills, both verbal and written.
Excellent ability to communicate independently and directly with customers, providers and staff with calmness, assertiveness, diplomacy and in a non-confrontational manner with the goal being to engage successfully with customers.
Ability to incorporate Evidence Based Innovation (EBI) practices and information into day-to-day customer engagement.
Demonstrated organizational skills, accountability, and personal ownership of work.
Excellent problem-solving and analytical skills.
Ability to identify trends in information, appropriately interpret information, and draw good conclusions from incomplete information.
Proficient in computer skills.
Valid driver’s license and ability to travel as needed, and reliable daily transportation.
Must be able to work flexible schedule including evening hours and weekends.
Associates degree in a health or human services field preferred.
Certification in healthcare-related field preferred.

Nice To Haves

Experience in Managed Care and/or working relationships with Medicare, Medicaid, or Social Service Agencies a plus.
Clinical experience a plus.
Spanish speaking communication (oral and/or written) is preferred.
Additional certifications in customer service or care coordination are a plus.

Responsibilities

Complete new customer welcome calls and support their transition to the Plan.
Provide ongoing information and assistance to customers to support accessing MVP programs, including connection with clinical programs and care management resources.
Build enduring relationships with customers.
Orient new members to specific product offerings and the services of the role.
Ensure the customer has a significant degree of understanding of their benefits, eligibility for certain services, and talk through and coordinate transition of care items.
Assist customers in addressing unmet needs recognizing that customers have needs beyond their standard benefit coverages.
Facilitate reduction of care disruption or delays in care and connection to clinical programs and Care Management resources.
Facilitate access to services which are culturally appropriate, meet the customer’s stated need for service and enhance the quality-of-service delivery.
Promote knowledge of health delivery system(s) to empower customer.
Collaborate with MVP Quality Management to support performance measurements.
Address other service needs as they arise from customers.
Accountable for resolution of highly complex customer issues.
Facilitate resolution of real and perceived disruptions of care as customer enrolls in MVP Medicare Advantage Product.
Participation in cross-departmental and external meetings and activities supporting customer, including with Care Pods and provider partners.
In-person attendance with Plan Guides at MVP events to support prospective customer inquiries.
On-site interactions with customers at MVP offices, community events, provider offices, etc.
Other duties as assigned by leadership.