Member and Recipient Services Coordinator (Full-time Remote, North Carolina Based)

Alliance Health•Fayetteville, NC

5d•$26 - $33•Remote

About The Position

The Member and Recipient Services Coordinator provide a broad range of customer service functions to individuals that contact the Tailored Plan (TP) Member and Recipient Services Call Center. This position provides general information regarding accessing services in the TP provider network, and on the various functions and processes of TP departments. This position assures consumers/guardians seeking routine services are referred to services or are transferred to licensed clinicians for clinical screening and triage. This position is full-time remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office may be required.

Requirements

Bachelor’s degree from an accredited college or university in Human Services or related field and four (4) years’ experience in a community, business or governmental program that delivers mental health support services (e.g., adults with mental illness, children with severe emotional disturbance, persons with developmental disabilities, adults and children with substance abuse disorders)
Knowledge of the six-county area and its human services agencies, community resources, churches, schools, and related organizations that provide services to clients and their families
Knowledge of TP care management programs
Knowledge of state and federal client rights protection statues, regulations, and applicable laws
Effective written and oral communication skill, interpersonal skills, excellent customer service skills
Ability to analyze oral and written information to identify rights protection complaint issues
Ability to multitask, manage time, prioritize work, and use problem-solving approaches
Ability to coordinate effectively with staff from various agencies
Ability to read, analyze, and interpret regulations, policies, and procedures to service providers
Ability to execute work plans and coordinate work effectively
Ability to operate computer equipment and generate reports and records
Proficient in using basic computer programs, internet
Ability to learn specific data programs used for call center tracking
Ability to triage caller needs for urgency and resolve issues in a calm and supportive manner
Ability to perform in a fast paced, ever changing and often high stress environment

Nice To Haves

Master’s degree and clinical experience preferred.

Responsibilities

Receive calls from members, recipients, and community stakeholders
Provide education to callers regarding all areas of TP functions
Availability and appropriateness of contracted providers
General information about managed care and NC Medicaid Tailored Plans
General information about state-funded services and NC Medicaid Direct
Benefit plans and member/recipient eligibility for services
Choosing and changing member PCPs
Choosing and changing AMH+ and care management entities
Role and expectation of care management entities
Grievance and complaint procedures
Navigating the Alliance Health website and member portal
Eligibility and scheduling transportation; Eligibility and referral for value added services
Maintain calm, helpful, appropriate demeanor and decision-making for all callers, including angry, abusive, threatening, and harassing callers
Escalate urgent and emergent calls to a licensed clinician
Complete routine screening and referral a timely manner
Assist callers with addressing obstacles to accessing care and identify available resources
Engage in follow-up activities to ensure consumers were seen for scheduled assessments and schedule aftercare appointments
Reschedule consumer missed appointments
Record consumer demographics in electronic health record (EHR)
Record grievances resolved and/or pending resolution
Receive, answer and record provider inquiries in EHR
Document all incoming call activity in EHR
Report patterns of atypical call and service seeking patterns to supervisor
Continue work efforts without interruption while managing technological disruptions and outages
Operate and navigate a multi-function phone system with multiple software programs while managing caller needs
Operate and navigate multiple software programs in course of all duties
Read, integrate, and adapt procedural tasks in a rapidly changing, paperless work environment
Work independently to prioritize tasks and maintain idle status in call queue during high call volume and/or low staffing periods
Monitor incoming fax system and overflow vendor reports to ensure written referrals receive appropriate attention within expected time frames
Train incoming staff to job duties and functions of the call center
Interact with community services orally while receiving information orally and in writing via IM, when called upon to do so
Engage interpreter services when needed and adjust communication accordingly
Troubleshooting of hardware and multiple software programs, including security protocols, VPN, and software behind the firewall